Provider Demographics
NPI:1467459115
Name:EADY, CHRISTINE M (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:EADY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 GATTIS SCHOOL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2037
Mailing Address - Country:US
Mailing Address - Phone:512-312-7230
Mailing Address - Fax:
Practice Address - Street 1:4810 GATTIS SCHOOL RD STE 100
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2037
Practice Address - Country:US
Practice Address - Phone:512-312-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041005201Medicaid
TX041005202OtherMEDICAID TX HEALTHSTEPS
TX82561XOtherBLUE CROSS BLUE SHIELD
TXTXB106274OtherPTAN
TX041005202Medicaid
G76542OtherUPIN
TX041005202OtherMEDICAID TX HEALTHSTEPS
TX041005202Medicaid