Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | D66747 | MD |
NPI | 1346441169 |
---|---|
Provider Name | Susan Therese Christ |
First Address | St Augustine, FL 32086-5134 |
Second Address | St Augustine, FL 32086-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 16/12/2016 |