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Contact Information

BRENT CHRISTENSEN, DPM
1777 E CLARK ST
SUITE 220
POCATELLO, ID83201-3357
 Phone: 208-235-1777
 Fax: 208-232-7518
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
 

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
Indicates primary specialty

NPI Profile & details for BRENT CHRISTENSEN · (Male)

NPI # 1487688990
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 07/10/2006
Last updated 06/20/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # P-166
  • ID Medicaid 806402300
  • ID Other P-1985 BLUE CROSS
  • ID Other 000010152768 BLUE SHEILD
  • ID Other 71-0943024 FEIN
  • ID Other P00031188 MEDICARE RAIL ROAD
Hospital affiliation(s)
  • CARIBOU MEMORIAL HOSPITAL - (Critical Access)
    300 SOUTH 3RD WEST
    SODA SPRINGS, ID 83276
  • PORTNEUF MEDICAL CENTER - (Acute Care)
    777 HOSPITAL WAY
    POCATELLO, ID 83201
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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