Provider Demographics
NPI:1386613842
Name:MANN, CHRISTOPHER R (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:MANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 OAK KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2527
Mailing Address - Country:US
Mailing Address - Phone:817-368-2255
Mailing Address - Fax:
Practice Address - Street 1:5601 BRIDGE ST STE 550
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-9502
Practice Address - Country:US
Practice Address - Phone:817-429-6010
Practice Address - Fax:817-429-6021
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2559207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A9852OtherBCBS
TX148295204Medicaid
TX148295204Medicaid
TXD97512Medicare UPIN