Provider Demographics
NPI:1245235688
Name:CHEN, CHRISTOPHER T (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2101 RIVERSIDE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6260
Practice Address - Country:US
Practice Address - Phone:954-341-6200
Practice Address - Fax:239-341-6204
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00876982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7719723-003OtherCIGNA PROVIDER NUMBER
FL289913OtherAVMED PROVIDER NUMBER
FL224345OtherWELLCARE
FL71699OtherBCBS PROVIDER NUMBER
FLQMP000003667233OtherMOLINA MCD
FL4099573OtherGHI PROVIDER NUMBER
FL7660443OtherAETNA PROVIDER NUMBER
FL7719723OtherCIGNA THRU THE KEYS PHA
FL267132800Medicaid
FL10236OtherDIMENSION PROVIDER NUMBER
FL289913OtherAVMED THRU KEYS PHA
FL7660443OtherAETNA THRU KEYS PHA
FL224345OtherWELLCARE PROVIDER NUMBER
FL8952OtherTOTAL HLTH CH. PROVIDER #
FL969200OtherUSA MNGD CR PROVIDER #
FL197042OtherAMERIGROUP PROVIDER NUM.
FL44989OtherNHP THRU PMG PROVIDER #
FLFLPV00003667233OtherMOLINA MCR
FLP0003149OtherFLORIDA HEALTHCARE PLUS
FLP0003149OtherFLORIDA HEALTHCARE PLUS
FL289913OtherAVMED THRU KEYS PHA
FLH84984Medicare UPIN