=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467455949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DON R CHRISTIAN JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 07/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1231 RIBAUT RD
-----------------------------------------------------
City | BEAUFORT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29902-6147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-525-6622
-----------------------------------------------------
Fax | 843-522-8243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2295 HENRY TECKLENBERG DR
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29414-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-766-7103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 22862
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------