Provider Demographics
NPI:1427303478
Name:CRAWFORD, CHRISTIAN T (PAC)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:T
Last Name:CRAWFORD
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6522
Mailing Address - Fax:208-955-6503
Practice Address - Street 1:1375 N HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5280
Practice Address - Country:US
Practice Address - Phone:208-809-2869
Practice Address - Fax:208-809-2870
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1361363A00000X
IDPA-1181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGJ628ZMedicare PIN