NPI age
19 years
Enumerated 2006-06-23
Across 56 active otolaryngology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 640005710 | RAILROAD MEDICARE IND # |
| 05 (ID) | 003659500 | |
| 01 (ID) | 57067 | BLUE CROSS |
| 01 (ID) | 000010003660 | REGENCE BLUE SHIELD |
| 01 (ID) | M5706 | IDAHO MEDICAL LICENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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