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General NPI Number Information
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NPI Number | 1497774772
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Entity Type | Organization
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Legal Business Name | ANTHONY MAISIN BUONCRISTIANI, MD
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 660 2ND AVE S UNIT A
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City | KETCHUM
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State | ID
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Zip | 83340
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Country | US
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Telephone | 208-622-3312
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Fax | 208-622-4919
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Provider Business Mailing Address
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Address Line | PO BOX 1332
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City | SUN VALLEY
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State | ID
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Zip | 83353-1332
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Country | US
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Telephone | 208-622-3312
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Fax | 208-622-4919
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ANTHONY M BUONCRISTIANI
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Credential | M.D.
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Telephone | 208-622-3312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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