Provider Demographics
NPI:1457848855
Name:SONG, CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 PAESANOS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1225
Mailing Address - Country:US
Mailing Address - Phone:210-492-8922
Mailing Address - Fax:210-479-2010
Practice Address - Street 1:3503 PAESANOS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1225
Practice Address - Country:US
Practice Address - Phone:210-492-8922
Practice Address - Fax:210-479-2010
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine