Healthcare Provider Details

I. General information

NPI: 1003490970
Provider Name (Legal Business Name): CHRISTIAN DE SOUZA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR # DC043.00
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR # DC043.00
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-8016
  • Fax:
Mailing address:
  • Phone: 573-884-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2024008940
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: