Provider Demographics
NPI:1770565871
Name:CHRISTIANSON, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHRISTIANSON
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:PO BOX 30976
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-0976
Mailing Address - Country:US
Mailing Address - Phone:406-238-6290
Mailing Address - Fax:406-238-6961
Practice Address - Street 1:1315 GOLDEN VALLEY CIR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6746
Practice Address - Country:US
Practice Address - Phone:406-238-6290
Practice Address - Fax:406-238-6961
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10533207RX0202X, 207RH0003X
WY7008A207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
810511516012OtherEBMS
WY312901OtherBLUE CROSS SHERIDAN WY
MT0079237Medicaid
WY119842400Medicaid
MT000097475OtherBLUE CROSS
WY312902OtherBLUE CROSS CODY WY
MTP00114253Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MT0079237Medicaid
MT000097475OtherBLUE CROSS
WYW10115Medicare UPIN