Provider Demographics
NPI:1114987666
Name:CHRISTENSEN, RICHARD CULL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CULL
Last Name:CHRISTENSEN
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 1:611 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2847
Mailing Address - Country:US
Mailing Address - Phone:904-394-8068
Mailing Address - Fax:904-353-7345
Practice Address - Street 1:611 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2847
Practice Address - Country:US
Practice Address - Phone:904-394-8068
Practice Address - Fax:904-353-7345
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME626822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000648227BMedicaid
FL260042608OtherRAILROAD MEDICARE
FL3764508-00Medicaid
FLF82352Medicare UPIN
FL68712XMedicare PIN