Provider Demographics
NPI:1760438238
Name:DEPALO, CHRISTOPHER P (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:DEPALO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N 22ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4963
Mailing Address - Country:US
Mailing Address - Phone:702-475-8400
Mailing Address - Fax:702-475-5005
Practice Address - Street 1:4845 S RAINBOW BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4916
Practice Address - Country:US
Practice Address - Phone:702-475-8400
Practice Address - Fax:702-475-5005
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4434207W00000X
OHDE4130181207W00000X
NVDO1810207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105738Medicaid
NV1760438238Medicaid
AZ109973Medicare PIN
NV1760438238Medicaid
AZ109972Medicare PIN
I04315Medicare UPIN