Healthcare Provider Details

I. General information

NPI: 1841282290
Provider Name (Legal Business Name): CRISTY MARK SCHADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 CHILDRESS AVE STE A
MESQUITE TX
75150-2808
US

IV. Provider business mailing address

PO BOX 850069
MESQUITE TX
75185-0069
US

V. Phone/Fax

Practice location:
  • Phone: 972-681-7246
  • Fax:
Mailing address:
  • Phone: 972-270-0600
  • Fax: 972-270-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberF1971
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberF1971
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberF1971
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: