Provider Demographics
NPI:1720015662
Name:KILLGOAR, CHRISTINA MOORE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MOORE
Last Name:KILLGOAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:DAWN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:BOX 6941
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4429
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4243
Practice Address - Fax:727-767-8612
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102202208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL492955OtherSTAYWELL/HEALTHEASE
FL7858470OtherAETNA
SCN01395Medicaid
FL324589OtherAVMED
NC890134NOMedicaid
FL000249800Medicaid
FL0592866OtherCIGNA
SCN01395Medicaid