Provider Demographics
NPI:1487668273
Name:CHRISTOPHER, KATHY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:ANN
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 STANDIFORD AVE
Mailing Address - Street 2:D3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6529
Mailing Address - Country:US
Mailing Address - Phone:209-575-4990
Mailing Address - Fax:209-575-4996
Practice Address - Street 1:2020 STANDIFORD AVE
Practice Address - Street 2:D3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6529
Practice Address - Country:US
Practice Address - Phone:209-575-4990
Practice Address - Fax:209-575-4996
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25743ZMedicare ID - Type UnspecifiedGROUP NUMBER
CAF98544Medicare UPIN