Provider Demographics
NPI:1730533886
Name:ELLEDGE, CHRISTEN RAE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:RAE
Last Name:ELLEDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3685 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2539
Mailing Address - Country:US
Mailing Address - Phone:314-257-7000
Mailing Address - Fax:314-257-7001
Practice Address - Street 1:3685 VISTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-257-7000
Practice Address - Fax:314-257-7001
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20210148622085R0001X
KS04-445392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology