Provider Demographics
NPI:1225020217
Name:CHENAULT, CHRISTOPHER SCROGGS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SCROGGS
Last Name:CHENAULT
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 1:1015 E 32ND ST
Mailing Address - Street 2:#101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-477-6341
Mailing Address - Fax:512-477-1148
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:#101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-477-6341
Practice Address - Fax:512-477-1148
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01579207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C14415Medicare UPIN
TX804429Medicare ID - Type Unspecified