MEDICARE: DR. CHRISTOPHER ROBERT ENTWISLE 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
1	207RG0100X	Gastroenterology Physician	A95045	CA

General Provider Information

NPI Number	:	1841256963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER ROBERT ENTWISLE M.D.

Provider Business Mailing Address
First Line	:	1133 E STANLEY BLVD
Second Line	:	SUITE 207
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4200
Country	:	US
Telephone Number	:	925-245-1238
Fax Number	:	925-245-9849

Provider Business Practice Location Address
First Line	:	1133 E STANLEY BLVD
Second Line	:	SUITE 207
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4200
Country	:	US
Telephone Number	:	925-245-1238
Fax Number	:	925-245-9849

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	04/08/2008

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