Provider Demographics
NPI:1760491542
Name:SCHOLES, CHRISTOPHER THAD (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:THAD
Last Name:SCHOLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:SCHOLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31001-3306
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-3306
Mailing Address - Country:US
Mailing Address - Phone:208-734-5555
Mailing Address - Fax:208-734-4790
Practice Address - Street 1:526 SHOUP AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6050
Practice Address - Country:US
Practice Address - Phone:208-734-5555
Practice Address - Fax:208-734-4790
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7237207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805062900Medicaid
IDG53527Medicare UPIN
ID1137528Medicare PIN