Provider Demographics
NPI:1225026412
Name:JUERGENS, CHRISTOPHER WARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WARD
Last Name:JUERGENS
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 1:3050 MACK RD
Mailing Address - Street 2:STE 310
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5376
Mailing Address - Country:US
Mailing Address - Phone:513-924-8895
Mailing Address - Fax:
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:STE. 205
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-924-8895
Practice Address - Fax:513-924-8910
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.068899208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2014653Medicaid
OHH163360Medicare PIN
OH2014653Medicaid