Provider Demographics
NPI:1780001966
Name:KANNADY, CHRISTOPHER RUSSELL
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RUSSELL
Last Name:KANNADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:KANNADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-724-4717
Mailing Address - Fax:281-729-8435
Practice Address - Street 1:1917 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3907
Practice Address - Country:US
Practice Address - Phone:281-724-4717
Practice Address - Fax:281-729-8435
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9506208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology