Provider Demographics
NPI:1275734022
Name:ROUSE, CHRISTOPHER ROBERT (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:ROUSE
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:816-892-5323
Mailing Address - Fax:816-584-0557
Practice Address - Street 1:4656 40TH AVE S STE 130
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4397
Practice Address - Country:US
Practice Address - Phone:701-234-8860
Practice Address - Fax:701-234-8924
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008007454207N00000X
ND23067207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39910018OtherBCBS
MOP00622825OtherRAILROAD MEDICARE
MOG26B00001Medicare PIN