NPI age
19 years
Enumerated 2007-01-24
Across 305 active specialist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 004401200 | |
| 01 (ID) | 000010025914 | BLUE SHIELD OF IDAHO ID# |
| 01 (ID) | 82-0510764 | TAX ID# |
| 01 (ID) | T-144-3 | BLUE CROSS OF IDAHO ID# |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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