Provider Demographics
NPI:1609085455
Name:CRAIG D HOLMAN CHARTERED
Entity Type:Organization
Organization Name:CRAIG D HOLMAN CHARTERED
Other - Org Name:MAGIC VALLEY FOOT & ANKLE SPECIALIST
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-734-7676
Mailing Address - Street 1:496 SHOUP AVE W # 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 # 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP119213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID185440600OtherUS DEPT OF LABOR
ID4134570001OtherDMERC
ID480031477OtherRAILROAD MEDICARE
ID000010152611OtherREGENCE BLUE SHIELD OF ID
IDP9343OtherBLUE CROSS OF IDAHO
ID480031477OtherRAILROAD MEDICARE
IDT44262Medicare UPIN