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General NPI Number Information
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NPI Number | 1699160093
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER CONTANCE MD
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 2525 HARBOR BLVD 310
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5317
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Country | US
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Telephone | 941-639-6556
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Fax | 941-639-6673
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Provider Business Mailing Address
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Address Line | PO BOX 495641
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-5641
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Country | US
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Telephone | 941-639-5665
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Fax | 941-639-6673
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER CONSTANCE
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Credential | MD
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Telephone | 941-639-5655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME59168
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License Number State | FL
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