Provider Demographics
NPI:1437138864
Name:CHURCH, CHRISTOPHER JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:CHURCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18205 N 51ST AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1490
Mailing Address - Country:US
Mailing Address - Phone:602-547-1400
Mailing Address - Fax:602-547-1401
Practice Address - Street 1:18205 N 51ST AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:602-547-1400
Practice Address - Fax:602-547-1401
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28790207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ67920OtherMEDICARE ID
AZ638934Medicaid
AZ638934Medicaid