MEDICARE: DR. CHRISTOPHER L QUEEN D.O.

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	207P00000X	Emergency Medicine Physician	5101017287	MI
2	207Q00000X	Family Medicine Physician	OS10481	FL
3	207Q00000X	Family Medicine Physician	061148	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1578754636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER L QUEEN D.O.

Provider Business Mailing Address
First Line	:	11380 NW 34TH PL
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-1442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1347 S ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1837
Country	:	US
Telephone Number	:	954-731-9444
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	04/02/2009

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Directions to “ DR. CHRISTOPHER L QUEEN D.O.” Practice Location

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