Healthcare Provider Details

I. General information

NPI: 1972129773
Provider Name (Legal Business Name): ALEXANDER JON CHRISTENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

5572 WATERMAN BLVD APT 1W
SAINT LOUIS MO
63112-1839
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6062
  • Fax:
Mailing address:
  • Phone: 309-339-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2020017220
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2022048177
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: