Provider Demographics
NPI:1255321261
Name:VETSCH, CHRISTIAN P (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:P
Last Name:VETSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:VETSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:208-463-3044
Practice Address - Street 1:215 E HAWAII AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6011
Practice Address - Country:US
Practice Address - Phone:208-463-3141
Practice Address - Fax:208-463-3044
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDJ66180OtherBLUE CROSS
ID14720OtherBLUE CROSS
ID000010003578OtherBLUE SHIELD
020023224OtherRAILROAD MEDICARE
000010027644OtherBLUE SHIELD
000010138645OtherBLUE SHIELD
ID002366500Medicaid
IDS5119OtherBLUE CROSS
ID14720OtherBLUE CROSS
ID002366500Medicaid
1130610Medicare PIN