Provider Demographics
NPI:1336130897
Name:CHRISTOPHER, RUSSELL L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:L
Last Name:CHRISTOPHER
Suffix:JR
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 1:1205 F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:1100 F AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1919
Practice Address - Country:US
Practice Address - Phone:520-364-1429
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG293952084P0800X
AZ420472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91190Medicare UPIN
CA00G293950Medicare ID - Type Unspecified