Provider Demographics
NPI:1093924813
Name:HOLMAN, CRAIG D (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:D
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 SHOUP AVE W STE B
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5043
Mailing Address - Country:US
Mailing Address - Phone:208-734-7676
Mailing Address - Fax:208-736-8378
Practice Address - Street 1:496 SHOUP AVE W STE B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5043
Practice Address - Country:US
Practice Address - Phone:208-734-7676
Practice Address - Fax:208-736-8378
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP119213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010015646OtherREGENCE BLUE SHIELD OF ID
ID002143900Medicaid
ID480031477OtherRAILROAD MEDICARE
IDP2397OtherBLUE CROSS OF IDAHO
ID1093924813Medicaid
ID4134570001OtherDMERC
ID820491190OtherPRIVATE INSURANCES
ID000010015646OtherREGENCE BLUE SHIELD OF ID
ID820491190OtherPRIVATE INSURANCES