Provider Demographics
NPI:1730380304
Name:LEDBETTER, CHRISTOPHER K (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:LEDBETTER
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 1:877 JEFFERSON AVE
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8202
Practice Address - Country:US
Practice Address - Phone:901-515-5704
Practice Address - Fax:901-515-5729
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44939208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4355605OtherBCBS
MS07150821Medicaid
TNP01288704OtherRAILROAD MEDICARE
AR177760001Medicaid
TNQ002444Medicaid
TN103I347162Medicare PIN