Healthcare Provider Details

I. General information

NPI: 1124553185
Provider Name (Legal Business Name): CHRISTOPHER BA LE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-2935
  • Fax:
Mailing address:
  • Phone: 407-891-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME155670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: