Healthcare Provider Details

I. General information

NPI: 1841576931
Provider Name (Legal Business Name): MR. CHRISTOPHER L PHOENIX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD SUITE 303
BOISE ID
83706-1338
US

IV. Provider business mailing address

901 N CURTIS RD SUITE 303
BOISE ID
83706-1338
US

V. Phone/Fax

Practice location:
  • Phone: 208-608-5048
  • Fax:
Mailing address:
  • Phone: 208-608-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 7538
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA2893
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: