Healthcare Provider Details

I. General information

NPI: 1598260374
Provider Name (Legal Business Name): CHRISTOPHER DON WHITTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19202 GROESCHKE RD
HOUSTON TX
77084-5600
US

IV. Provider business mailing address

2026 MARLBERRY LN
HOUSTON TX
77084-4533
US

V. Phone/Fax

Practice location:
  • Phone: 281-237-3098
  • Fax:
Mailing address:
  • Phone: 281-698-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT2168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: