Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | M5058 | ID |
NPI | 1003979352 |
---|---|
Provider Name | Dr. Craig Z. Hall |
First Address | Idaho Falls, ID 83401-4360 |
Second Address | Idaho Falls, ID 83401-4360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010005741 | BLUE SHIELD OF IDAHO (01) | ID |
003742900 | (05) | ID |
50583 | BLUE CROSS OF IDAHO (01) | ID |
C36963 | (02) | ID |