Provider Demographics
NPI:1003979352
Name:HALL, CRAIG Z (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:Z
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CRAIG
Other - Middle Name:Z
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1660 JOHN ADAMS PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4360
Mailing Address - Country:US
Mailing Address - Phone:208-523-8844
Mailing Address - Fax:208-529-8684
Practice Address - Street 1:1660 JOHN ADAMS PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4360
Practice Address - Country:US
Practice Address - Phone:208-523-8844
Practice Address - Fax:208-529-8684
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005741OtherBLUE SHIELD OF IDAHO
ID50583OtherBLUE CROSS OF IDAHO
ID003742900Medicaid
ID50583OtherBLUE CROSS OF IDAHO
ID1373497Medicare ID - Type UnspecifiedMEDICARE