NPI age
20 years
Enumerated 2006-05-23
Across 260 active surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | 82040040083501A002 | TRICARE/TRIWEST |
| 05 (ID) | 002599000 | |
| 01 (WA) | 8911902 | WA CRIME VICTIMS PROGRAM |
| 01 (ID) | D0485 | BLUE CROSS OF IDAHO |
| 01 | 020005019 | MEDICARE RAILROAD |
| 01 (ID) | 000010002660 | REGENCE BLUE SHIELD OF ID |
| 01 (WA) | 0093025 | WASHINGTON LABOR & INDUST |
| 05 (WA) | 1014216 |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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