Provider Demographics
NPI:1710902655
Name:LEBRUN, CHRISTOPHER T (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
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 1:1801 ORANGE TREE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4587
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-557-1732
Practice Address - Street 1:4500 BROCKTON AVE STE 306
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4027
Practice Address - Country:US
Practice Address - Phone:951-977-2460
Practice Address - Fax:951-977-2444
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422624207X00000X, 207XX0801X
MDD0069284207XX0801X
COC172147207XX0801X
CAC172147207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherAVMED
MD952901OtherCAREFIRST MD BCBS-WMG
FL9801151OtherAETNA
CACA479677Medicaid
PA2108660OtherHIGHMARK BLUE SHIELD-WMG
MD417879301Medicaid
MD1710902655OtherNPI
PA416145OtherUPMC-WMG
PA102310711Medicaid
PA1583229OtherGATEWAY-WMG
FL277217500Medicaid
PA30084123OtherAMERIHEALTH MERCY-WMG
FL6314726OtherCIGNA
MDD0069284OtherMD LICENSE
FLPENDINGOtherBC/BS
FL9801151OtherAETNA
MD1710902655OtherNPI
PA30084123OtherAMERIHEALTH MERCY-WMG