Provider Demographics
NPI:1598935694
Name:CHRISTOPHER T OFFUTT
Entity Type:Organization
Organization Name:CHRISTOPHER T OFFUTT
Other - Org Name:CHRISTOPHER T OFFUTT DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:OFFUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-587-0330
Mailing Address - Street 1:2415 MULLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-4274
Mailing Address - Country:US
Mailing Address - Phone:719-587-0330
Mailing Address - Fax:719-587-0440
Practice Address - Street 1:2415 MULLINS AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-4274
Practice Address - Country:US
Practice Address - Phone:719-587-0330
Practice Address - Fax:719-587-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00513213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01005131Medicaid
CO3968140001Medicare NSC
COU63816Medicare UPIN
CO01005131Medicaid