Healthcare Provider Details

I. General information

NPI: 1083604045
Provider Name (Legal Business Name): CHRISTOPHER ROBERT MCNULTY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MEDICAL CENTER POINT
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

2 SOUTH CASCADE AVENUE SUITE 140
COLORADO SPRINGS CO
80903-1604
US

V. Phone/Fax

Practice location:
  • Phone: 719-636-2999
  • Fax: 719-667-4105
Mailing address:
  • Phone: 719-538-2900
  • Fax: 719-538-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1926
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0045851
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG8547
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0045851
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: