Healthcare Provider Details

I. General information

NPI: 1093819021
Provider Name (Legal Business Name): ANTHONY J CHR ISTOFF D O
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N CASCADE AVE
COLORADO SPGS CO
80903-3289
US

IV. Provider business mailing address

715 N CASCADE AVE
COLORADO SPGS CO
80903-3289
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-9891
  • Fax: 719-471-4493
Mailing address:
  • Phone: 719-471-9891
  • Fax: 719-471-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34580
License Number StateCO

VIII. Authorized Official

Name: ANTHONY JAMES CHRISTOFF
Title or Position: PRESIDENT PHYSICIAN
Credential: D.O.
Phone: 719-471-9891