Provider Demographics
NPI:1073826178
Name:LIBY, CHRISTOPHER JORDAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JORDAN
Last Name:LIBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:541-523-1797
Mailing Address - Fax:541-523-1799
Practice Address - Street 1:3325 POCAHONTAS ROAD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1464
Practice Address - Country:US
Practice Address - Phone:541-523-1797
Practice Address - Fax:541-523-1799
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018888208600000X
ORDO171722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery