Healthcare Provider Details

I. General information

NPI: 1265889000
Provider Name (Legal Business Name): CHRISTOPHER BERNARD GILSDORF D.O., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

2617 EMORILAND BLVD
KNOXVILLE TN
37917-2309
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9290
  • Fax:
Mailing address:
  • Phone: 480-234-6062
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3461
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: