Provider Demographics
NPI:1801889639
Name:CONSTANCE, CHRISTOPHER G (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:G
Last Name:CONSTANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:941-639-5665
Mailing Address - Fax:
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:310
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:941-639-5665
Practice Address - Fax:941-255-8746
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0059168208200000X, 2082S0099X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26188OtherBCBS
FLF90055Medicare UPIN
FL26188Medicare PIN
FL26188OtherBCBS