Provider Demographics
NPI:1326160789
Name:SOFIANOS, CHRISTOPHER GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:SOFIANOS
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 1:25231 PINSON DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8844
Mailing Address - Country:US
Mailing Address - Phone:173-250-9579
Mailing Address - Fax:239-931-5060
Practice Address - Street 1:7152 COCA SABAL LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-939-9939
Practice Address - Fax:239-931-5060
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135437207RG0100X
IN01060913A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200875680Medicaid
354590WWMedicare PIN