=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376860916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFERY STEVEN CHRISTENSEN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2010
-----------------------------------------------------
Last Update Date | 08/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 W 2ND ST STE 415
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601-2467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-237-5848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 W 2ND ST STE 415
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601-2467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-237-5848
-----------------------------------------------------
Fax | 877-991-5063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 9728A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------