Provider Demographics
NPI:1841282290
Name:SCHADE, CRISTY MARK (MD)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:MARK
Last Name:SCHADE
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:PO BOX 850069
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-0069
Mailing Address - Country:US
Mailing Address - Phone:972-270-0600
Mailing Address - Fax:972-270-0051
Practice Address - Street 1:3865 CHILDRESS AVE STE A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2808
Practice Address - Country:US
Practice Address - Phone:972-681-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1971207L00000X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097798503Medicaid
TX097798504Medicaid
TX097798502Medicaid
TX8C6391Medicare PIN
TXC21601Medicare UPIN
TX613547Medicare PIN