Charles Malcolm Clair JR.
Family Doctor
1071 Renee Ave
Pocatello
, Idaho 83201-2508
Charles Malcolm Clair JR.
Family Doctor
1071 Renee Ave
Pocatello
, Idaho 83201-2508
(208) 436-0481
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About
Features
Specialties
- Family Doctor
Languages spoken
- English
Location
First Address
- Charles Malcolm Clair JR.
- 1322 Stoneridge Dr
- Pocatello, ID
- Zip : 83201-5043
- Phone : (208) 436-0481
Second Address
- Charles Malcolm Clair JR.
- 1071 Renee Ave
- Pocatello, ID
- Zip : 83201-2508
- Fax : (208) 269-7094
- Phone : (208) 252-5602
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Q00000X | Family Doctor | M-10525 | ID |
National Provider Identifier
| NPI | 1003012204 |
|---|---|
| Provider Name | Charles Malcolm Clair JR. |
| First Address | Pocatello, ID 83201-5043 |
| Second Address | Pocatello, ID 83201-2508 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/06/2007 |
| Last Update Date | 06/05/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 11479847 | AAMC ID (01) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.