Provider Demographics
NPI:1316905839
Name:DEBACKER, CHRISTOPHER MACDONALD (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MACDONALD
Last Name:DEBACKER
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 592329
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0166
Mailing Address - Country:US
Mailing Address - Phone:210-495-2367
Mailing Address - Fax:
Practice Address - Street 1:1314 E SONTERRA BLVD
Practice Address - Street 2:SUITE 5104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4278
Practice Address - Country:US
Practice Address - Phone:210-495-2367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85368207W00000X
TXN5646207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101680OtherINDIVIDUAL PTAN
G20554Medicare UPIN