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General NPI Number Information
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NPI Number | 1144773524
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Entity Type | Individual
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Provider Name | CHRISTOPHER M HANIFORD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-365-6820
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Fax | 719-365-6595
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Provider Business Mailing Address
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Address Line | 71 PORTERS PASS APT #1
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City | BERLIN
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State | CT
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Zip | 06037-1415
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Country | US
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Telephone | 727-543-1043
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3715
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005780
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License Number State | CO
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