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General NPI Number Information
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NPI Number | 1730450016
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Entity Type | Individual
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Provider Name | MICHAEL GREGORY PUGSLEY-CHRISTENSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 4790 INVERNESS DRIVE
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City | POST FALLS
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State | ID
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Zip | 83854
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Country | US
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Telephone | 208-777-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 4790 INVERNESS DRIVE
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City | POST FALLS
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State | ID
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Zip | 83854
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Country | US
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Telephone | 208-777-4334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | M-36224
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License Number State | ID
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