Provider Demographics
NPI:1992827653
Name:BONG, CHRISTINE JANEL HAYWOOD (MD, FAAP, MPH)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:JANEL HAYWOOD
Last Name:BONG
Suffix:
Gender:F
Credentials:MD, FAAP, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 SLATE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2922
Mailing Address - Country:US
Mailing Address - Phone:719-313-3267
Mailing Address - Fax:719-309-6847
Practice Address - Street 1:2960 N CIRCLE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-634-8891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47375208000000X
SCLL28136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37336843Medicaid
SCLL28136OtherLIMITED MEDICAL LICENSE
COCO306759OtherMEDICARE PTAN
CO47375OtherMEDICAL LICENSE
CO47375OtherMEDICAL LICENSE
COFB1340912OtherDEA