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General NPI Number Information
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NPI Number | 1053817452
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Entity Type | Individual
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Provider Name | CHRISTOPHER VAN DAMME
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Gender | Male
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 4915 E BASELINE RD STE 121
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City | GILBERT
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State | AZ
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Zip | 85234-2969
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Country | US
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Telephone | 480-812-6882
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 W GLENDALE AVE STE 100
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City | PHOENIX
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State | AZ
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Zip | 85021-8862
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0001002
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License Number State | AZ
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