NPI age
20 years
Enumerated 2005-09-13
Across 1263 active physician assistant providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | P00815198 | RR MEDICARE |
| 05 (ID) | 1780679068 | |
| 01 (ID) | PAWB1 | BCI |
| 05 (WA) | 1018848 | |
| 01 (WA) | P00749511 | RR MEDICARE |
| 01 (IN) | 1780679068 | REGENCE BLUE SHIELD |
Part of a multi-provider practice. 56 other active providers share this practice address in NPPES.
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