Provider Demographics
NPI:1881894673
Name:MENENDEZ, CHRISTOPHER ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ANTONIO
Last Name:MENENDEZ
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 1:701 S HORSEBARN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8796
Mailing Address - Country:US
Mailing Address - Phone:314-953-6886
Mailing Address - Fax:314-953-6887
Practice Address - Street 1:1225 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8012
Practice Address - Country:US
Practice Address - Phone:314-953-6886
Practice Address - Fax:314-953-6887
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8334208600000X
TXN0272208600000X, 207R00000X
MO2011029723208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ005OtherBCBS
TX194488601Medicaid
TX194488602Medicaid
TX8K8685Medicare PIN