Provider Demographics
NPI:1457594012
Name:MICKLER, CHRISTOPHER REGAR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:REGAR
Last Name:MICKLER
Suffix:
Gender:M
Credentials:DO
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 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:400 PINELLAS ST
Practice Address - Street 2:SUITE 325
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3312
Practice Address - Country:US
Practice Address - Phone:727-298-6121
Practice Address - Fax:727-533-5903
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10561207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001440400Medicaid
FLP00737110OtherRAILROAD MEDICARE PROVIDER NUMBER
FL001440400Medicaid
FLBY038YMedicare PIN