Provider Demographics
NPI:1477693786
Name:M. BRUCE CHRISTOPHERSON,MD,PA
Entity Type:Organization
Organization Name:M. BRUCE CHRISTOPHERSON,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURDOTH
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:CHRISTOPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-467-4883
Mailing Address - Street 1:1140 BUSINESS CENTER DR STE 390
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2737
Mailing Address - Country:US
Mailing Address - Phone:713-467-4883
Mailing Address - Fax:713-467-4970
Practice Address - Street 1:1140 BUSINESS CENTER DR STE 390
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:713-467-4883
Practice Address - Fax:713-467-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8175261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00EC42Medicare ID - Type UnspecifiedMEDICARE NUMBER
TXD98081Medicare UPIN