Provider Demographics
NPI:1083025415
Name:ANDERSON, CHRISTINE LEE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
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:NAVY MEDICINE READINESS & TRAINING UNIT FORT WORTH
Mailing Address - Street 2:1711 DOOLITTLE AVE
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVY MEDICINE READINESS & TRAINING UNIT FORT WORTH
Practice Address - Street 2:1711 DOOLITTLE AVE
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127
Practice Address - Country:US
Practice Address - Phone:817-782-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN