NPI age
20 years
Enumerated 2005-06-21
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010140515 | BS |
| 01 (ID) | 85795 | BC |
| 05 (ID) | 806406200 |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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