Healthcare Provider Details

I. General information

NPI: 1558367003
Provider Name (Legal Business Name): STEPHEN DENNEY CHRISTIANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 E INDEPENDENCE ST SUITE B
SPRINGFIELD MO
65804-4262
US

IV. Provider business mailing address

1335 E INDEPENDENCE ST SUITE B
SPRINGFIELD MO
65804-4262
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-8818
  • Fax: 417-886-9836
Mailing address:
  • Phone: 417-881-8818
  • Fax: 417-886-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2C53
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier201732906
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: