Provider Demographics
NPI:1902976566
Name:OFFUTT, CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:OFFUTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MULLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-4274
Mailing Address - Country:US
Mailing Address - Phone:719-587-0330
Mailing Address - Fax:719-587-0440
Practice Address - Street 1:2415 MULLINS AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-4274
Practice Address - Country:US
Practice Address - Phone:719-587-0330
Practice Address - Fax:719-587-0440
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC50583213ES0103X
CO00513213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01005131Medicaid
COU63816Medicare UPIN
CO3968140001Medicare NSC
CO01005131Medicaid