Provider Demographics
NPI:1811968217
Name:STREETER, CHRISTOPHER D (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:STREETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:208-381-5970
Mailing Address - Fax:208-381-5971
Practice Address - Street 1:413 N ALLUMBAUGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9212
Practice Address - Country:US
Practice Address - Phone:208-381-5970
Practice Address - Fax:208-381-5971
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-120892084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM-12089OtherSTATE MEDICAL BOARD
IDM-12089OtherSTATE MEDICAL BOARD