Provider Demographics
NPI:1154595056
Name:PHILIP, CHRISTO THOMAS (MD)
Entity type:Individual
Prefix:
First Name:CHRISTO
Middle Name:THOMAS
Last Name:PHILIP
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 1:6451 BRENTWOOD STAIR RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3200
Mailing Address - Country:US
Mailing Address - Phone:817-496-9700
Mailing Address - Fax:817-507-1759
Practice Address - Street 1:6451 BRENTWOOD STAIR RD
Practice Address - Street 2:SUITE #200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3200
Practice Address - Country:US
Practice Address - Phone:817-496-9700
Practice Address - Fax:817-507-1759
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN4669207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program