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NPI Code Detail

MEDICARE: DR. CHRISTOPHER W PERGREM M.D.

MEDICARE: DR. CHRISTOPHER W PERGREM M.D.
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
1207P00000XEmergency Medicine Physician36395KY
2207P00000XEmergency Medicine Physician39044CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336126408
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER W PERGREM M.D.
Provider Business Mailing Address
First Line : 4535 DRESSLER RD NW
Second Line :
City : CANTON
State : OH
Zip : 44718-2545
Country : US
Telephone Number : 855-687-0618
Fax Number :
Provider Business Practice Location Address
First Line : 12911 W 40TH AVE
Second Line :
City : GOLDEN
State : CO
Zip : 80401-2696
Country : US
Telephone Number : 303-425-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 12/08/2024

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