Provider Demographics
NPI:1497761910
Name:FLETCHER, CHRISTOPHER RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RICHARD
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANTA FE
Other - Middle Name:FAMILY
Other - Last Name:PRACTICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2015 GALISTEO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2101
Mailing Address - Country:US
Mailing Address - Phone:505-989-9144
Mailing Address - Fax:505-989-1550
Practice Address - Street 1:2015 GALISTEO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2101
Practice Address - Country:US
Practice Address - Phone:505-989-9144
Practice Address - Fax:505-989-1550
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81-45207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09860Medicaid
NM201003116OtherPRESBYTERIAN
NMP00020256OtherRAILROAD MEDICARE
NMPROVP12654OtherMOLINA SALUD
NMNM004585OtherBCBS
NMPROVP12654OtherMOLINA SALUD
NM2121929Medicare PIN