Provider Demographics
NPI:1467696088
Name:POOLE, CHRISTOPHER D (IDMT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:POOLE
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MACDILL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:33621-1607
Mailing Address - Country:US
Mailing Address - Phone:813-827-9805
Mailing Address - Fax:
Practice Address - Street 1:8415 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:MACDILL AFB
Practice Address - State:FL
Practice Address - Zip Code:33621-1604
Practice Address - Country:US
Practice Address - Phone:813-827-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians