Provider Demographics
NPI:1295711810
Name:LOO, CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LOO
Suffix:
Gender:F
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 LIVE OAK ST
Practice Address - Street 2:COPC ADMINISTRATION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6153
Practice Address - Country:US
Practice Address - Phone:214-266-1247
Practice Address - Fax:214-266-1246
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155632614Medicaid
TX155632622Medicaid
TX155632621Medicaid
TX155632605Medicaid
TX155632607Medicaid
TX155632615Medicaid
TX155632624Medicaid
TX155632602Medicaid
TX155632610Medicaid
TX155632616Medicaid
TX155632625Medicaid
TX155632609Medicaid
TX155632619Medicaid
TX155632604Medicaid
TX155632620Medicaid
TX155632606Medicaid
TX155632608Medicaid
TX155632612Medicaid
TX155632617Medicaid
TX155632623Medicaid
TX155632618Medicaid
TX155632626Medicaid
TX8W8851OtherBLUE CROSS BLUE SHIELD
TX155632624Medicaid
TX8A5007Medicare PIN