Provider Demographics
NPI:1598732513
Name:SONNIER, CHRISTOPHER SHANE (MD, FACE, ECNU)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:SONNIER
Suffix:
Gender:
Credentials:MD, FACE, ECNU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 NW MYHRE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7662
Mailing Address - Country:US
Mailing Address - Phone:564-240-4120
Mailing Address - Fax:564-240-4159
Practice Address - Street 1:1950 NW MYHRE RD FL 2
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7662
Practice Address - Country:US
Practice Address - Phone:564-240-4120
Practice Address - Fax:564-240-4159
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60489-20207RE0101X
VA0101235399207RE0101X
MO2023048377207RE0101X
WAMD60890016207RE0101X
MN108570207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920093Medicaid
SC266456Medicaid
VA010314186Medicaid
SCP01072416OtherRAILROAD MEDICARE
WV3810006557Medicaid
VA010314186Medicaid
NHT400152200Medicare PIN
WV3810006557Medicaid
SCAA61446066Medicare PIN