NPI age
16 years
Enumerated 2009-10-02
Across 1263 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 10000704157 | BS |
| 05 (ID) | 808529900 | |
| 01 (ID) | PA099 | BC |
Solo or small practice. No other active providers share this practice address in NPPES.
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