Healthcare Provider Details

I. General information

NPI: 1205986916
Provider Name (Legal Business Name): CHRISTOPHER GEORGE VENDRYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9526 NE 2ND AVE SUITE #101
MIAMI SHORES FL
33138-2750
US

IV. Provider business mailing address

9526 NE 2ND AVE SUITE #101
MIAMI SHORES FL
33138-2750
US

V. Phone/Fax

Practice location:
  • Phone: 305-694-3775
  • Fax: 305-694-3697
Mailing address:
  • Phone: 305-694-3775
  • Fax: 305-694-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0039411
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME0039411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: