Provider Demographics
NPI:1932708286
Name:MACASIO, CHRISTOPHER PLUMOS
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PLUMOS
Last Name:MACASIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2094
Mailing Address - Country:US
Mailing Address - Phone:903-681-0976
Mailing Address - Fax:
Practice Address - Street 1:1912 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2094
Practice Address - Country:US
Practice Address - Phone:903-681-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255793208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation