Provider Demographics
NPI:1003079195
Name:ANDERSON, CHRISTOPHER LYNN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 NICKEL LOOP
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2200
Mailing Address - Country:US
Mailing Address - Phone:504-253-4715
Mailing Address - Fax:504-253-4717
Practice Address - Street 1:1790 SATURN BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129
Practice Address - Country:US
Practice Address - Phone:504-253-4715
Practice Address - Fax:504-253-4717
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider