Individual
CHRISTIAN T SHULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2330 DESOTO ST, IDAHO FALLS, ID 83404-7570
(208) 523-1100
(208) 523-1317
Mailing address
2330 DESOTO ST, IDAHO FALLS, ID 83404-7570
(208) 523-1100
(208) 523-1317
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
M8794
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148914
BLUE SHIELD OF IDAHO
ID
01
—
72496
BLUE CROSS OF IDAHO
ID
01
—
P000048425 P00241090
RR MEDICARE
ID
Enumeration date
01/22/2007
Last updated
07/08/2007
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