NPI age
20 years
Enumerated 2005-10-21
Across 38 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010004875 | BLUE SHIELD |
| 01 (ID) | J3979 | BLUE CROSS |
| 01 (ID) | 000010004876 | BLUE SHIELD |
| 01 (ID) | 38737 | BLUE CROSS |
Part of a multi-provider practice. 25 other active providers share this practice address in NPPES.
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