Provider Demographics
NPI:1073668042
Name:CRAIS, THOMAS FLOYD JR
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FLOYD
Last Name:CRAIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2741
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-2741
Mailing Address - Country:US
Mailing Address - Phone:208-788-7700
Mailing Address - Fax:208-788-3100
Practice Address - Street 1:315 S RIVER ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8426
Practice Address - Country:US
Practice Address - Phone:208-788-7700
Practice Address - Fax:208-788-3100
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-80822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDB63446Medicare UPIN