Provider Demographics
NPI:1538148598
Name:CHRISTENSEN, NEIL DREW (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:DREW
Last Name:CHRISTENSEN
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 1:380 E MAIN ST # B-120
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-6801
Mailing Address - Country:US
Mailing Address - Phone:435-214-7282
Mailing Address - Fax:928-433-4666
Practice Address - Street 1:380 E MAIN ST # B-120
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-6801
Practice Address - Country:US
Practice Address - Phone:435-214-7282
Practice Address - Fax:928-433-4666
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ381608Medicaid
G45400Medicare UPIN
Z26663Medicare PIN
AZ381608Medicaid