Provider Demographics
NPI:1134184716
Name:OPELLA, CHRISTOPHER M (MD)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:M
Last Name:OPELLA
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 1:601 NORTHWEST PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2930
Mailing Address - Country:US
Mailing Address - Phone:817-270-0788
Mailing Address - Fax:817-752-2176
Practice Address - Street 1:1 BURNT CHURCH RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6405
Practice Address - Country:US
Practice Address - Phone:817-270-0788
Practice Address - Fax:817-752-2176
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5370207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162606101Medicaid
SC872201Medicaid
TX8DM120OtherBCBS
TX0009DVOtherBLUE CROSS BLUE SHIELD
TX162606101Medicaid
TX930080888Medicare PIN
TX259908YCCMMedicare PIN
TX8DM120OtherBCBS