Healthcare Provider Details

I. General information

NPI: 1124389093
Provider Name (Legal Business Name): CHRISTOPHER BRYAN HOVLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTOPER B HOVLAND MD

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW H K DODGEN LOOP BLDG 300
TEMPLE TX
76502-1814
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-5437
  • Fax:
Mailing address:
  • Phone: 254-724-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPIT 566341
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ4132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: