Provider Demographics
NPI:1134112345
Name:BYNUM, CHRISTOPHER KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KELLY
Last Name:BYNUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:KELLY
Other - Last Name:BYNUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:910 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4226
Mailing Address - Country:US
Mailing Address - Phone:970-249-6641
Mailing Address - Fax:970-249-5148
Practice Address - Street 1:910 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4226
Practice Address - Country:US
Practice Address - Phone:970-249-6641
Practice Address - Fax:970-249-5148
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40526207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62858521Medicaid
COH52559Medicare UPIN
CO464598Medicare ID - Type Unspecified