Healthcare Provider Details

I. General information

NPI: 1902907967
Provider Name (Legal Business Name): CHRISTINA E. STIXRUD & ASSOCIATES, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E BROADWAY SUITE 203
COLUMBIA MO
65201-8018
US

IV. Provider business mailing address

1701 E BROADWAY SUITE 203
COLUMBIA MO
65201-8018
US

V. Phone/Fax

Practice location:
  • Phone: 573-441-1000
  • Fax: 573-441-1010
Mailing address:
  • Phone: 573-441-1000
  • Fax: 573-441-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004014283
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2004014283
License Number StateMO

VIII. Authorized Official

Name: DR. CHRISTINA ELAINE STIXRUD IV
Title or Position: OWNER
Credential: M.D.
Phone: 573-441-1000