Doctor Name: | DR. CHRISTOPHER M EDENS |
NPI Number: | 1437311891 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 29661 |
Business Practice Address: | 2200 Bergquist Dr 59 Mdsp/sgmd Jbsa Lackland, TX - 782369907 |
Business Phone Number: | 2102925350 |
Business Fax Number: | 2102923781 |
Mailing Address: | 2200 Bergquist Dr, 59 Mdsp/sgmd JBSA LACKLAND |
State: | TX |
Postal Code: | 782369907 |
Phone Number: | 2102925350 |
Fax Number: | 2102923781 |
NPI Enumeration Date: | 06/26/2008 |
NPI Last Update Date: | 08/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 29661 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |