Provider Demographics
NPI:1437111267
Name:HIROSE, CHRISTOPHER B (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
Last Name:HIROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E. GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-8600
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:901 N. CURTIS RD
Practice Address - Street 2:STE 503
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1343
Practice Address - Country:US
Practice Address - Phone:208-367-3330
Practice Address - Fax:208-337-1003
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42650207X00000X
IDM-10746207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808406100Medicaid
CO47370572Medicaid
CO47370572Medicaid
540398Medicare ID - Type Unspecified