Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | O-0986 | ID |
NPI | 1295094217 |
---|---|
Provider Name | Dr. James Kendall Christensen |
First Address | Blackfoot, ID 83221-1758 |
Second Address | Idaho Falls, ID 83404-8280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 14/09/2016 |