Provider Demographics
NPI:1336126408
Name:PERGREM, CHRISTOPHER W (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:PERGREM
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 1:4535 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2545
Mailing Address - Country:US
Mailing Address - Phone:855-687-0618
Mailing Address - Fax:
Practice Address - Street 1:12911 W 40TH AVE
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2696
Practice Address - Country:US
Practice Address - Phone:303-425-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36395207P00000X
CO39044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73105031Medicaid
COE50227Medicare ID - Type Unspecified
COH03733Medicare UPIN