NPI age
19 years
Enumerated 2006-05-28
Across 245 active psychiatry & neurology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1942257548 | |
| 01 (ID) | 78119 | BLUE CROSS |
| 01 (ID) | 000010144418 | REGENCE BLUE SHIELD |
Part of a multi-provider practice. 39 other active providers share this practice address in NPPES.
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