Provider Demographics
NPI:1003922634
Name:ESPANA, CHRISTOPHER BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:ESPANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-851-1000
Mailing Address - Fax:314-851-4449
Practice Address - Street 1:5034 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3418
Practice Address - Country:US
Practice Address - Phone:314-843-7333
Practice Address - Fax:314-843-9946
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007898207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201195401Medicaid
MOI57044Medicare UPIN
MO201195401Medicaid