Provider Demographics
NPI:1780818286
Name:BLANTON, CHRISTIE BEAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:BEAN
Last Name:BLANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CHRISTIE
Other - Middle Name:J
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3586
Mailing Address - Country:US
Mailing Address - Phone:303-440-3216
Mailing Address - Fax:303-440-3209
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3586
Practice Address - Country:US
Practice Address - Phone:303-440-3216
Practice Address - Fax:303-440-3209
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204373207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program