NPI age
20 years
Enumerated 2006-02-15
Across 8 active obstetrics & gynecology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 50112 | BLUE CROSS OF IDAHO |
| 05 (ID) | 806431500 | |
| 01 (ID) | CS9457 | IDAHO CONTROLLED SUBSTANC |
| 01 (ID) | 000010139641 | REGENCE BLUE SHIELD |
| 01 (ID) | 13D0521509 | CLIA LAB ID NUMBER |
| 01 (ID) | M-8503 | STATE LISCENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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