NPI age
19 years
Enumerated 2006-07-07
Across 260 active surgery providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (WA) | 1116375 | |
| 05 (ID) | 002704000 | |
| 01 (ID) | 020040062 | RR MEDICARE |
| 01 (ID) | 10439 | BC ID |
Part of a multi-provider practice. 65 other active providers share this practice address in NPPES.
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