Provider Demographics
NPI:1215195334
Name:EYRE, CHRISTOPHER ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ADAM
Last Name:EYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:148 BLUE LAKES BLVD N # 363
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5235
Mailing Address - Country:US
Mailing Address - Phone:208-595-5095
Mailing Address - Fax:208-595-5258
Practice Address - Street 1:1502 LOCUST ST N STE 700
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4164
Practice Address - Country:US
Practice Address - Phone:208-595-5095
Practice Address - Fax:208-595-5258
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM11659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1215195334Medicaid
ID1215195334Medicaid