MEDICARE: MR. CHRISTOPHER A INEAMA PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246QM0706X	Medical Technologist	010468-1	NY
2	363A00000X	Physician Assistant	012149-1	NY
3	363A00000X	Physician Assistant	PA05609	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063601300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER A INEAMA PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	3750 S UNIVERSITY DR # 275
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3795
Country	:	US
Telephone Number	:	817-294-9600
Fax Number	:	817-294-9611

Provider Business Practice Location Address
First Line	:	3750 S UNIVERSITY DR # 275
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3795
Country	:	US
Telephone Number	:	817-294-9600
Fax Number	:	817-294-9611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	07/21/2022

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Directions to “ MR. CHRISTOPHER A INEAMA PHYSICIAN ASSISTANT” Practice Location

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