Provider Demographics
NPI:1184629727
Name:CHRISTENSEN, CULLEY K (MD)
Entity Type:Individual
Prefix:DR
First Name:CULLEY
Middle Name:K
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-0129
Mailing Address - Country:US
Mailing Address - Phone:505-661-9118
Mailing Address - Fax:505-661-9192
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:SUITE 139
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-661-9118
Practice Address - Fax:505-661-9192
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDR.0001925207X00000X
NMMD2011-0257207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5198914OtherCIGNA
AZ592161OtherUNITED HEALTHCARE
AZAZ0265290OtherBLUE CROSS & BLUE SHIELD
AZ598184OtherGREAT WEST HEALTHCARE
AZA002OtherTRI CARE WEST REGION
AZ0545630001OtherDME NATIONAL SUPPLIER NUMBER
AZ4021841OtherAETNA
AZ1Z9392OtherHEALTH NET MEDICARE
OH378534900OtherOHIO BOARD OF WORKMEN'S C
AZ66890OtherHUMANA GOLD
AZ4021841OtherAETNA
AZ4021841OtherAETNA
AZ592161OtherUNITED HEALTHCARE