Provider Demographics
NPI:1376636464
Name:MANN, CHRISTOPHER M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:MANN
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9232207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118488100OtherFIRSTCARE PIN
TX123494003Medicaid
1447220850OtherGRP NPI NUMBER
TX137345809Medicaid
TX1822828OtherPHCS PIN
TX00N47FOtherBCBSTX GRP PIN
TX1393097OtherUHC PIN
TX88070GOtherBCBSTX IND PIN
TX4672147OtherAETNA PIN
TX123494002Medicaid
TX5129074OtherCCN PIN
TX7753742OtherCIGNA PIN
TX862623OtherFIRSTHEALTH PIN
TX10006590OtherAMERIGROUP PIN
TX108095OtherSUPERIOR PIN
TX140442853Medicaid
TX1393097OtherUHC PIN
G13563Medicare UPIN
TX87262JMedicare ID - Type UnspecifiedIND MEDICARE