Healthcare Provider Details

I. General information

NPI: 1487060117
Provider Name (Legal Business Name): EDWARD JAMES KRAJICEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6259 W EMERALD ST
BOISE ID
83704-8731
US

IV. Provider business mailing address

6259 W EMERALD ST
BOISE ID
83704-8731
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-1900
  • Fax:
Mailing address:
  • Phone: 208-489-1900
  • Fax: 208-375-5286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM14916
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: