Provider Demographics
NPI:1861689572
Name:ENNIS, CRISTIANE CAMPOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTIANE
Middle Name:CAMPOS
Last Name:ENNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7629 HILLSIDE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-8385
Mailing Address - Country:US
Mailing Address - Phone:806-641-8400
Mailing Address - Fax:806-803-9429
Practice Address - Street 1:7629 HILLSIDE RD STE 200
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-8385
Practice Address - Country:US
Practice Address - Phone:806-641-8000
Practice Address - Fax:806-803-9429
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine