Provider Demographics
NPI:1548217524
Name:ANDERSHOCK, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:ANDERSHOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 PISGAH RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5407
Mailing Address - Country:US
Mailing Address - Phone:901-337-0961
Mailing Address - Fax:
Practice Address - Street 1:1585 PISGAH RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5407
Practice Address - Country:US
Practice Address - Phone:901-337-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36690207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00232038OtherRAILROAD MEDICARE
TN3879163Medicaid
TN4041777OtherBLUE CROSS
MS00126505Medicaid
AR156279001Medicaid
TN3879163Medicare PIN
TN3879163Medicaid