Provider Demographics
NPI:1134150550
Name:POINDEXTER MYATT, CHRISTINE P (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:P
Last Name:POINDEXTER MYATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MYATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1700 N MCMULLEN BOOTH RD
Mailing Address - Street 2:STE D-1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2130
Mailing Address - Country:US
Mailing Address - Phone:727-669-3800
Mailing Address - Fax:727-669-5600
Practice Address - Street 1:1700 N MCMULLEN BOOTH RD
Practice Address - Street 2:STE D-1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2130
Practice Address - Country:US
Practice Address - Phone:727-669-3800
Practice Address - Fax:727-669-5600
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4163207R00000X, 208M00000X
FLME105258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001336500Medicaid
G13647Medicare UPIN
FL001336500Medicaid