Healthcare Provider Details

I. General information

NPI: 1538173950
Provider Name (Legal Business Name): CHRISTOPHER JOHN GORDON CHISHOLM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD SUITE 107
POWAY CA
92064-2068
US

IV. Provider business mailing address

PO BOX 501724
SAN DIEGO CA
92150-1724
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-7700
  • Fax: 858-947-3828
Mailing address:
  • Phone: 619-894-1975
  • Fax: 858-798-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA86646
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number67636
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA86646
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number67636
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA86646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: