NPI age
20 years
Enumerated 2006-04-03
Across 10 active radiology providers in Idaho.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 82R448 | BLUE CROSS |
| 01 | 123729100 | FIRSTCARE |
| 01 (TX) | MDJ2321 | WORKERS COMPENSATION |
| 05 (NM) | Q3953 | |
| 05 (TX) | 103357301 | |
| 05 (OK) | 100155790A |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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