Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | M-8082 | ID |
NPI | 1073668042 |
---|---|
Provider Name | Dr. Thomas Floyd Crais JR. |
First Address | Hailey, ID 83333-2741 |
Second Address | Hailey, ID 83333-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 20/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B63446 | (02) | ID |