Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 283559 | NY |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | S4821 | TX |
N | 207Q00000X | Family Doctor | 283559 | NY |
N | 207Q00000X | Family Doctor | S4821 | TX |
NPI | 1386904225 |
---|---|
Provider Name | Dr. Christopher Ariel Medina |
First Address | Fort Worth, TX 76107-2553 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 14/07/2020 |