Doctor Name: | MR. CHRISTOPHER RAY SUNDQUIST |
NPI Number: | 1366510752 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PAC |
License Number: | PA-303 |
Business Practice Address: | 6101 W Hwy 54 Suite A Athol, ID - 83801 |
Business Phone Number: | 2086830800 |
Business Fax Number: | 2086830900 |
Mailing Address: | Po Box 775, ATHOL |
State: | ID |
Postal Code: | 83801 |
Phone Number: | 2086830800 |
Fax Number: | 2086830900 |
NPI Enumeration Date: | 12/01/2006 |
NPI Last Update Date: | 08/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA-303 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |