Provider Demographics
NPI:1093819021
Name:ANTHONY J CHR ISTOFF D O
Entity Type:Organization
Organization Name:ANTHONY J CHR ISTOFF D O
Other - Org Name:ANTHONY J CHRISTOF DO PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CHRISTOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-471-9891
Mailing Address - Street 1:715 N CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3289
Mailing Address - Country:US
Mailing Address - Phone:719-471-9891
Mailing Address - Fax:719-471-4493
Practice Address - Street 1:715 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3289
Practice Address - Country:US
Practice Address - Phone:719-471-9891
Practice Address - Fax:719-471-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345800Medicaid
COC02302Medicare PIN
CO01345800Medicaid