Provider Demographics
NPI:1114991858
Name:CONNELLY, CHRIS FOUST (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:FOUST
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6106B ILLAHEE RD NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9691
Mailing Address - Country:US
Mailing Address - Phone:360-476-1714
Mailing Address - Fax:360-476-2480
Practice Address - Street 1:1400 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98314-6001
Practice Address - Country:US
Practice Address - Phone:360-476-1714
Practice Address - Fax:360-476-2480
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA1433OP2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine