Provider Demographics
NPI:1285746198
Name:EBERT-SANTOS, CHRISTINE A (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:EBERT-SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4250
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-4250
Mailing Address - Country:US
Mailing Address - Phone:970-668-1616
Mailing Address - Fax:970-668-5650
Practice Address - Street 1:730 N SUMMIT BLVD
Practice Address - Street 2:STE 101
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-1616
Practice Address - Fax:970-668-5650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38349208000000X
CO0038349208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38284570Medicaid
CO62732862Medicaid