Healthcare Provider Details

I. General information

NPI: 1558321323
Provider Name (Legal Business Name): CHRISTINE MEASHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 S MILLENIUM WAY
MERIDIAN ID
83642-6439
US

IV. Provider business mailing address

1618 S MILLENIUM WAY STE 100
MERIDIAN ID
83642-6457
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-1969
  • Fax:
Mailing address:
  • Phone: 208-884-3376
  • Fax: 208-884-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberM8951
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: