NPI age
19 years
Enumerated 2006-08-21
Across 305 active specialist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 001529600 | |
| 01 (ID) | 000010006068 | REGENCE |
| 01 (ID) | 0083005 | DLI |
| 01 (ID) | 13DO521109 | LAB |
| 05 (WA) | 1502103 |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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