Provider Demographics
NPI:1912011032
Name:CASE, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:CASE
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2140
Practice Address - Fax:817-332-2506
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK13852080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87Z122OtherBCBSTX IND PIN
TX118768408Medicaid
TX6558202OtherCIGNA PIN
TX00U87ZOtherBCBSTX GRP PIN
TX113957OtherSUPERIOR PIN
TX118768402Medicaid
TX118768409OtherCSHCN
TX140442852Medicaid
TX10006572OtherAMERIGROUP PIN
TX4490096OtherAETNA PIN
TX137345810Medicaid
TX1392786OtherUHC PIN
TX773171OtherFIRSTHEALTH PIN
TX109994100OtherFIRSTCARE PIN
TX118768401Medicaid
E45694Medicare UPIN
TX113957OtherSUPERIOR PIN
TX140442852Medicaid
TX118768402Medicaid