MEDICARE: DR. CHRISTOPHER BOYD CHISHOLM MD

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	207P00000X	Emergency Medicine Physician	01050378A	IN

General Provider Information

NPI Number	:	1407836075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER BOYD CHISHOLM MD

Provider Business Mailing Address
First Line	:	PO BOX 197829
Second Line	:
City	:	AGANA HEIGHTS
State	:	GU
Zip	:	96919-7829
Country	:	US
Telephone Number	:	671-471-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	US NAVAL HOSPITAL GUAM
Second Line	:	FARENHOLT AVE BLD K1
City	:	AGANA HEIGHTS
State	:	GU
Zip	:	96919-7829
Country	:	US
Telephone Number	:	671-344-9619
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	12/12/2013

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