Healthcare Provider Details

I. General information

NPI: 1982624516
Provider Name (Legal Business Name): CHRISTOPHER MARTIN CODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6811
US

IV. Provider business mailing address

724 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6811
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-1610
  • Fax: 559-323-1760
Mailing address:
  • Phone: 559-323-1610
  • Fax: 559-323-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG58035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: