Provider Demographics
NPI:1659725851
Name:NEVALA-PLAGEMANN, CHRISTOPHER DUANE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DUANE
Last Name:NEVALA-PLAGEMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E # SOM
Mailing Address - Street 2:DEPARTMENT OF MEDICINE - ROOM 4C116
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-581-7899
Mailing Address - Fax:801-585-0418
Practice Address - Street 1:30 N 1900 E # SOM
Practice Address - Street 2:DEPARTMENT OF MEDICINE - ROOM 4C116
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-581-7899
Practice Address - Fax:801-585-0418
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10514857-1205207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology