Provider Demographics
NPI:1407860539
Name:PITTMAN, CHRISTOPHER LACYE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LACYE
Last Name:PITTMAN
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 1:2000 S 42ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-2001
Mailing Address - Country:US
Mailing Address - Phone:501-228-7200
Mailing Address - Fax:501-228-2285
Practice Address - Street 1:2000 S 42ND ST STE 100
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-2001
Practice Address - Country:US
Practice Address - Phone:479-273-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174817001Medicaid
MO84068OtherAR BLUE SHIELD
MO201324704Medicaid
MO959153230Medicare PIN
MOI59845Medicare UPIN
AR174817001Medicaid
MO959153268Medicare PIN