Provider Demographics
NPI:1346977667
Name:BURY, KHRISTOFFER A
Entity Type:Individual
Prefix:MR
First Name:KHRISTOFFER
Middle Name:A
Last Name:BURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GRAND BLVD LOS PRADOS APT 21203
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3375
Mailing Address - Country:US
Mailing Address - Phone:956-844-1574
Mailing Address - Fax:
Practice Address - Street 1:400 GRAND BLVD LOS PRADOS APT 21203
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3375
Practice Address - Country:US
Practice Address - Phone:956-844-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program