Provider Demographics
NPI:1912904780
Name:MANSEAU, CHRISTOPHER JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:MANSEAU
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 1:2685 SW 32ND PL STE 400
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7866
Mailing Address - Country:US
Mailing Address - Phone:352-624-0004
Mailing Address - Fax:352-624-3090
Practice Address - Street 1:2685 SW 32ND PL STE 400
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7866
Practice Address - Country:US
Practice Address - Phone:352-624-0004
Practice Address - Fax:352-624-3090
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-04-11
Deactivation Date:2006-07-20
Deactivation Code:
Reactivation Date:2007-01-24
Provider Licenses
StateLicense IDTaxonomies
FLME73474207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252721900Medicaid
P00391904OtherMEDICARE RAILROAD
P00391904OtherMEDICARE RAILROAD
FLG07752Medicare UPIN
FL5844920001Medicare NSC