NPI age
17 years
Enumerated 2009-05-01
Across 228 active obstetrics & gynecology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (OR) | 500609069 | |
| 01 (ID) | 808416200 | IDAHO MEDICAID |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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