Provider Demographics
NPI:1588713358
Name:MANATT, CHRISTOPHER SCOTT (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:MANATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 E SAN ANTONIO ST
Mailing Address - Street 2:SUITE 509E
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6050
Mailing Address - Country:US
Mailing Address - Phone:361-573-6351
Mailing Address - Fax:361-575-6455
Practice Address - Street 1:605 E SAN ANTONIO ST
Practice Address - Street 2:SUITE 509E
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6050
Practice Address - Country:US
Practice Address - Phone:361-573-6351
Practice Address - Fax:361-575-6455
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ41133208800000X
TXN2638208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00890691OtherMEDICARE RAILROAD
TX7604423386179OtherCHAMPUS TRICARE
TX002807191OtherUNITED HEALTH CARE
TX8FC798OtherBLUE CROSS/BLUE SHIELD OF TEXAS
TX201477102Medicaid
TXTXB114930Medicare PIN