Healthcare Provider Details

I. General information

NPI: 1801889639
Provider Name (Legal Business Name): CHRISTOPHER G CONSTANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 HARBOR BLVD 310
PORT CHARLOTTE FL
33952-5317
US

IV. Provider business mailing address

2525 HARBOR BLVD SUITE 310
PORT CHARLOTTE FL
33952-5317
US

V. Phone/Fax

Practice location:
  • Phone: 941-639-5665
  • Fax: 941-255-8746
Mailing address:
  • Phone: 941-639-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME-0059168
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME-0059168
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME-0059168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: