NPI age
13 years
Enumerated 2012-06-12
Across 1691 active family medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (CO) | DR.0054726 | |
| 01 (ID) | M12236 | ID LICENSE |
| 01 (CO) | 028795 | KAISER COMMERCIAL NUMBER |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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