Provider Demographics
NPI:1598732513
Name:SONNIER, CHRISTOPHER SHANE (MD, FACE, ECNU)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:SONNIER
Suffix:
Gender:M
Credentials:MD, FACE, ECNU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 W 32ND ST STE 402
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1639
Mailing Address - Country:US
Mailing Address - Phone:417-347-8740
Mailing Address - Fax:417-347-8734
Practice Address - Street 1:1102 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3503
Practice Address - Country:US
Practice Address - Phone:417-347-3659
Practice Address - Fax:417-347-9085
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60489-20207RE0101X
VA0101235399207RE0101X, 207RE0101X
MO2023048377207RE0101X
MN108570207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920093Medicaid
SCP01072416OtherRAILROAD MEDICARE
VA010314186Medicaid
SC266456Medicaid
WV3810006557Medicaid
VA010314186Medicaid
NHT400152200Medicare PIN
WV3810006557Medicaid
SCAA61446066Medicare PIN