Provider Demographics
NPI:1538142534
Name:CLEVENGER, CHRISTOPHER EARL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EARL
Last Name:CLEVENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 CASS ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4548
Mailing Address - Country:US
Mailing Address - Phone:831-648-3361
Mailing Address - Fax:831-375-5824
Practice Address - Street 1:980 CASS ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4548
Practice Address - Country:US
Practice Address - Phone:831-648-3361
Practice Address - Fax:831-375-5824
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84499207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA184178500OtherDOL
CA00G844990Medicare ID - Type Unspecified