Provider Demographics
NPI:1902134935
Name:CHRISTOPHER, CLINTON WAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:WAYNE
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6836 BEE CAVE RD
Mailing Address - Street 2:STE 116
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5059
Mailing Address - Country:US
Mailing Address - Phone:512-524-2290
Mailing Address - Fax:512-524-2291
Practice Address - Street 1:6836 BEE CAVE RD
Practice Address - Street 2:STE 116
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5059
Practice Address - Country:US
Practice Address - Phone:512-524-2290
Practice Address - Fax:512-524-2291
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L26991Medicare PIN
TX8L27054Medicare PIN