Provider Demographics
NPI:1063415404
Name:SCHALLER, CHRISTINE C (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:C
Last Name:SCHALLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:77 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-5347
Mailing Address - Country:US
Mailing Address - Phone:208-983-3744
Mailing Address - Fax:208-298-4520
Practice Address - Street 1:2315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:208-983-5120
Practice Address - Fax:208-983-5404
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0265455OtherLABOR & INDUSTRIES
ID1063415404OtherREGENCE BLUESHIELD
ID1063415404Medicaid
WA2009649Medicaid
IDP00884048OtherRR MEDICARE
ID78399OtherBC/ID
WAG8907267Medicare PIN
WA0265455OtherLABOR & INDUSTRIES
IDP00884048OtherRR MEDICARE