NPI age
19 years
Enumerated 2006-07-19
Across 387 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | PA-467 | STATE LICENSE |
| 05 (ID) | 806708000 |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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