Healthcare Provider Details

I. General information

NPI: 1710902655
Provider Name (Legal Business Name): CHRISTOPHER T LEBRUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE STE 306
RIVERSIDE CA
92501-4027
US

IV. Provider business mailing address

1801 ORANGE TREE LN STE 200
REDLANDS CA
92374-4587
US

V. Phone/Fax

Practice location:
  • Phone: 951-977-2460
  • Fax: 951-977-2444
Mailing address:
  • Phone: 909-557-1600
  • Fax: 909-557-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD422624
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberD0069284
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMD422624
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberC172147
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC172147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: