Healthcare Provider Details

I. General information

NPI: 1588944516
Provider Name (Legal Business Name): MARK DEAN CHRISTENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE J
CASTLE PINES CO
80108-9454
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 301
HIGHLANDS RANCH CO
80129-2277
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax: 303-814-6491
Mailing address:
  • Phone: 303-814-0505
  • Fax: 303-814-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA115152
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDR.0056009
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56009
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: