Provider Demographics
NPI:1053337709
Name:EGBUCHUNAM, CHRISTIE U (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:U
Last Name:EGBUCHUNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 REGENCY PKWY
Mailing Address - Street 2:SUITE 509
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3794
Mailing Address - Country:US
Mailing Address - Phone:817-453-2323
Mailing Address - Fax:817-453-2322
Practice Address - Street 1:305 REGENCY PKWY
Practice Address - Street 2:SUITE 509
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3794
Practice Address - Country:US
Practice Address - Phone:817-453-2323
Practice Address - Fax:817-453-2322
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179924901Medicaid
TX8K4033OtherBLUE CROSS BLUE SHIELD
TX179924902Medicaid
TX179924902Medicaid
TX179924901Medicaid