Provider Demographics
NPI:1063601300
Name:INEAMA, CHRISTOPHER A (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:A
Last Name:INEAMA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:A
Other - Last Name:INEAMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:3750 S UNIVERSITY DR # 275
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3795
Mailing Address - Country:US
Mailing Address - Phone:817-294-9600
Mailing Address - Fax:817-294-9611
Practice Address - Street 1:3750 S UNIVERSITY DR # 275
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3795
Practice Address - Country:US
Practice Address - Phone:817-294-9600
Practice Address - Fax:817-294-9611
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010468-1246QM0706X
NY012149-1363A00000X
TXPA05609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2825044Medicaid
TX2825044Medicaid