MEDICARE: DR. CULLEY K CHRISTENSEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	CDR.0001925	CO
2	207X00000X	Orthopaedic Surgery Physician	MD2011-0257	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	1Z9392	OTHER	AZ	HEALTH NET MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5198914	OTHER	AZ	CIGNA
2	592161	OTHER	AZ	UNITED HEALTHCARE
4	598184	OTHER	AZ	GREAT WEST HEALTHCARE
5	A002	OTHER	AZ	TRI CARE WEST REGION
6	0545630001	OTHER	AZ	DME NATIONAL SUPPLIER NUMBER
7	4021841	OTHER	AZ	AETNA
9	378534900	OTHER	OH	OHIO BOARD OF WORKMEN'S C
10	66890	OTHER	AZ	HUMANA GOLD

General Provider Information

NPI Number	:	1184629727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CULLEY K CHRISTENSEN MD

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-0129
Country	:	US
Telephone Number	:	505-661-9118
Fax Number	:	505-661-9192

Provider Business Practice Location Address
First Line	:	3917 WEST RD
Second Line	:	SUITE 139
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2275
Country	:	US
Telephone Number	:	505-661-9118
Fax Number	:	505-661-9192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/29/2022

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Directions to “ DR. CULLEY K CHRISTENSEN MD” Practice Location

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