Provider Demographics
NPI:1639308836
Name:BROADWAY, CHRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BROADWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 N HIGHWAY 77 STE 210
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7832
Mailing Address - Country:US
Mailing Address - Phone:972-937-1210
Mailing Address - Fax:972-937-0243
Practice Address - Street 1:1700 N HIGHWAY 77 STE 210
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7832
Practice Address - Country:US
Practice Address - Phone:972-937-1210
Practice Address - Fax:972-937-0243
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP8016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DZ581OtherBLUE CROSS