Provider Demographics
NPI:1891821856
Name:AGRICOLA, CHRISTIAN DAVID FRIEDRICH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DAVID FRIEDRICH
Last Name:AGRICOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 N 400 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1310
Mailing Address - Country:US
Mailing Address - Phone:801-574-8401
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-581-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6348818-89052084P0800X
UT6348818-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry