Individual
ANTHONY MAISIN BUONCRISTIANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
660 2ND AVE S, UNIT A, KETCHUM, ID 83340
(208) 622-3312
(208) 622-4919
Mailing address
PO BOX 1332, SUN VALLEY, ID 83353-1332
(208) 622-3311
(208) 622-4919
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-9501
ID
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
M-9501
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807513700
—
ID
01
—
P00381131
RR MEDICARE
ID
Enumeration date
05/26/2006
Last updated
04/26/2024
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