Healthcare Provider Details

I. General information

NPI: 1689906281
Provider Name (Legal Business Name): CHRISTOPHER E BACKUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

IV. Provider business mailing address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-2135
  • Fax:
Mailing address:
  • Phone: 850-881-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101250158
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: