Provider Demographics
NPI:1447238688
Name:CHRISTENSEN, JAMES LEROY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEROY
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0564
Mailing Address - Country:US
Mailing Address - Phone:620-251-1100
Mailing Address - Fax:620-251-7466
Practice Address - Street 1:209 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-4903
Practice Address - Country:US
Practice Address - Phone:620-251-1100
Practice Address - Fax:620-251-7466
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-19197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS009707OtherBLUE CROSS BLUE SHIELD
KSD89706Medicare UPIN
KS009707OtherBLUE CROSS BLUE SHIELD