Provider Demographics
NPI:1962478297
Name:CHRISTOPHERSON, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-0820
Mailing Address - Country:US
Mailing Address - Phone:605-940-7583
Mailing Address - Fax:712-478-4086
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-1000
Practice Address - Fax:712-478-4086
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD3582207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0002413OtherBCBS
MO208527408Medicaid
SD5700620Medicaid
TX1632937-01Medicaid
MN203285600Medicaid
IA0992750Medicaid
MN9F315CHOtherBCBS
MN203285600Medicaid
TX1632937-01Medicaid
TX1632937-01Medicaid