Provider Demographics
NPI:1649226317
Name:LEBRUN, CHRISTOPHER JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:LEBRUN
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 1:129 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-329-3838
Mailing Address - Fax:662-329-2515
Practice Address - Street 1:129 N BROOKMOORE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2024
Practice Address - Country:US
Practice Address - Phone:662-329-3838
Practice Address - Fax:662-329-2515
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17679207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125750Medicaid
H64431Medicare UPIN
MS00125750Medicaid