Healthcare Provider Details

I. General information

NPI: 1669785564
Provider Name (Legal Business Name): CHRISTOPHER LEE CRAIG CST, CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4376
US

IV. Provider business mailing address

205 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4376
US

V. Phone/Fax

Practice location:
  • Phone: 281-480-7832
  • Fax: 281-480-7504
Mailing address:
  • Phone: 281-480-7832
  • Fax: 281-480-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: