Healthcare Provider Details

I. General information

NPI: 1215195334
Provider Name (Legal Business Name): CHRISTOPHER ADAM EYRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LOCUST ST N STE 700
TWIN FALLS ID
83301-4164
US

IV. Provider business mailing address

148 BLUE LAKES BLVD N # 363
TWIN FALLS ID
83301-5235
US

V. Phone/Fax

Practice location:
  • Phone: 208-595-5095
  • Fax: 208-595-5258
Mailing address:
  • Phone: 208-595-5095
  • Fax: 208-595-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM11659
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: