NPI age
19 years
Enumerated 2006-06-12
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010004744 | BLUE SHIELD |
| 05 (ID) | 002556300 | |
| 01 (ID) | 4248-1 | BLUE CROSS |
Part of a multi-provider practice. 64 other active providers share this practice address in NPPES.
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