NPI age
20 years
Enumerated 2005-06-17
Across 100 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | 327497 | BLUE SHIELD |
| 05 (ID) | 805536100 | |
| 01 | KOO J1338 | BLUE CROSS |
Part of a multi-provider practice. 19 other active providers share this practice address in NPPES.
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