Healthcare Provider Details

I. General information

NPI: 1699074013
Provider Name (Legal Business Name): CHRISTOPHER LEE ENDRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 GOTT ROAD VANCE CLINIC
VANCE AFB OK
73705
US

IV. Provider business mailing address

527 GOTT ROAD VANCE CLINIC
VANCE AFB OK
73705
US

V. Phone/Fax

Practice location:
  • Phone: 580-213-7919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: