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General NPI Number Information
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NPI Number | 1538336532
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Entity Type | Organization
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Legal Business Name | TOM CRAIS MD PC
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 315 S RIVER ST
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City | HAILEY
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State | ID
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Zip | 83333
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Country | US
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Telephone | 208-788-7700
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Fax | 208-788-3100
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Provider Business Mailing Address
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Address Line | PO BOX 2741
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City | HAILEY
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State | ID
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Zip | 83333
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Country | US
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Telephone | 208-788-7700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | TOM F CRAIS
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Credential | MD
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Telephone | 208-788-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M8082
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | M8082
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License Number State | ID
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