Provider Demographics
NPI:1154301869
Name:CHRISTOPHER, JAMES WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARREN
Last Name:CHRISTOPHER
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 1:29 EAGLE TRCE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6759
Mailing Address - Country:US
Mailing Address - Phone:985-626-3810
Mailing Address - Fax:
Practice Address - Street 1:233 SAINT ANN DR STE 3
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3395
Practice Address - Country:US
Practice Address - Phone:985-635-0074
Practice Address - Fax:985-635-0799
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.024148208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57120Medicaid
LA5E692Medicare ID - Type Unspecified
LA57120Medicaid
LA4M843DF89Medicare PIN
LA5E865Medicare ID - Type Unspecified