NPI age
20 years
Enumerated 2005-10-21
Across 1263 active physician assistant providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010145450 | BLUE SHIELD |
| 01 (ID) | DAGV3 | BLUE CROSS |
| 01 (ID) | 000010145449 | BLUE SHIELD |
| 05 (ID) | 806749400 | |
| 01 (ID) | PAG001 | BLUE CROSS |
| 01 (ID) | P00160006 | RAILROAD MEDICARE |
Part of a multi-provider practice. 47 other active providers share this practice address in NPPES.
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