NPI age
19 years
Enumerated 2006-07-07
Across 252 active pediatrics providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (WA) | 2079474 | |
| 05 (ID) | 1851323950 |
Part of a multi-provider practice. 56 other active providers share this practice address in NPPES.
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