Provider Demographics
NPI:1477553840
Name:DEVINE, CHRISTOPHER LEONARD (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEONARD
Last Name:DEVINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3186
Mailing Address - Country:US
Mailing Address - Phone:561-791-4434
Mailing Address - Fax:561-795-0464
Practice Address - Street 1:1395 S STATE ROAD 7 STE 300
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9326
Practice Address - Country:US
Practice Address - Phone:561-791-4434
Practice Address - Fax:561-795-0464
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2019-03-07
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLOS7229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252605100Medicaid
FL252605100Medicaid
G47697Medicare UPIN