Provider Demographics
NPI:1619974599
Name:JOHN, CHRISTOPHER LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEIGH
Last Name:JOHN
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 1:11321 INTERSTATE 30
Mailing Address - Street 2:STE 306
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7067
Mailing Address - Country:US
Mailing Address - Phone:501-407-0200
Mailing Address - Fax:501-407-0220
Practice Address - Street 1:11321 INTERSTATE 30
Practice Address - Street 2:STE 306
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7067
Practice Address - Country:US
Practice Address - Phone:501-407-0200
Practice Address - Fax:501-407-0220
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2644207R00000X, 207RC0200X
ARE6244207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110209691OtherRAILROAD MC
4823006OtherUNITED HC
AK140774001Medicaid
4548106OtherACTNA
5L554Medicare ID - Type Unspecified
110209691OtherRAILROAD MC