Provider Demographics
NPI:1457945115
Name:VAN NISPEN, CHRISTIAAN ARNOUD SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAAN
Middle Name:ARNOUD SIMON
Last Name:VAN NISPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:DEPT OF MEDICINE, MCHE-MDX
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-916-4789
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:DEPT OF MEDICINE, MCHE-MDX
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7823
Practice Address - Country:US
Practice Address - Phone:210-916-4789
Practice Address - Fax:210-916-6654
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0452207P00000X, 208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program