Christensen, Brian Wade
Christensen, Brian Wade is an sole proprietor health care provider with primary practice located at 20 Madison Professional Park , Rexburg ID 83440-2058. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Christensen, Brian Wade can be contacted via phone (208) 656-9008.Contact Information
Primary practice address
20 Madison Professional Park
Rexburg ID 83440-2058
Phone: (208) 656-9008
Fax: (208) 656-0999
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | M7414 | Idaho |
Profile Details
| NPI number | 1811022056 |
|---|---|
| LBN Legal business name | Christensen, Brian Wade |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 21st, 2007 |
| Last updated | Jul 9th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811022056 | NPPES |
| Idaho | Other | DT307 | BLUE SHIELD |
| Idaho | Other | 000010004529 | BLUE SHIELD |
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