Provider Demographics
NPI:1881685584
Name:GIST, CHRISTOPHER W (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:GIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 43100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3100
Mailing Address - Country:US
Mailing Address - Phone:520-348-7900
Mailing Address - Fax:520-244-1209
Practice Address - Street 1:1100 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4606
Practice Address - Country:US
Practice Address - Phone:520-348-7900
Practice Address - Fax:520-244-1209
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ61478208800000X
PAMD450397208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071698Medicaid
PA0025570830001Medicaid
IN200893660Medicaid
IN146470E3OtherMEDICARE
PA323553Medicare PIN