Provider Demographics
NPI:1023029675
Name:CHRISTOPHERSON, M BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:M BRUCE
Middle Name:
Last Name:CHRISTOPHERSON
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 1:929 GESSNER RD
Mailing Address - Street 2:STE. 2130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2515
Mailing Address - Country:US
Mailing Address - Phone:713-935-9100
Mailing Address - Fax:713-935-9103
Practice Address - Street 1:929 GESSNER RD
Practice Address - Street 2:STE. 2130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2515
Practice Address - Country:US
Practice Address - Phone:713-935-9100
Practice Address - Fax:713-935-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8175207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD98081Medicare UPIN
TX1023029675Medicare PIN