NPI age
14 years
Enumerated 2011-06-15
Across 1691 active family medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1780979914 | |
| 01 (ID) | M-12473 | MEDICAL LICENSE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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