Provider Demographics
NPI:1063588622
Name:MCINTYRE, CHRISTIN J (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIN
Middle Name:J
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W IRONWOOD DR STE 303
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2682
Mailing Address - Country:US
Mailing Address - Phone:503-276-1295
Mailing Address - Fax:234-444-5496
Practice Address - Street 1:1250 W IRONWOOD DR STE 303
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2682
Practice Address - Country:US
Practice Address - Phone:503-276-1295
Practice Address - Fax:234-444-5496
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD229102084P0800X
WAMD610227822084P0800X
IDM-166182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119787Medicare UPIN