Healthcare Provider Details

I. General information

NPI: 1437320256
Provider Name (Legal Business Name): CHRISTIAN ALLEN SELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 RICHMOND MDWS
TEXARKANA TX
75503-0067
US

IV. Provider business mailing address

4102 RICHMOND MDWS
TEXARKANA TX
75503-0067
US

V. Phone/Fax

Practice location:
  • Phone: 903-223-1014
  • Fax: 903-223-1028
Mailing address:
  • Phone: 903-223-1014
  • Fax: 903-223-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA102830
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP7949
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE8081
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: