NPI age
19 years
Enumerated 2006-06-06
Across 97 active physician assistant providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010151808 | BLUE SHIELD |
| 01 (ID) | P00281050 | RR MEDICARE |
| 05 (ID) | 807249500 | |
| 01 (ID) | PAYD5 | BLUE CROSS |
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
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