1710902655 NPI number — CHRISTOPHER T LEBRUN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710902655 NPI number — CHRISTOPHER T LEBRUN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBRUN
Provider First Name:
CHRISTOPHER
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710902655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 ORANGE TREE LN STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92374-4587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-557-1600
Provider Business Mailing Address Fax Number:
909-557-1732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 BROCKTON AVE STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92501-4027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-977-2460
Provider Business Practice Location Address Fax Number:
951-977-2444
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD422624 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0801X , with the licence number: D0069284 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0801X , with the licence number: MD422624 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0801X , with the licence number: C172147 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: C172147 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 952901 . This is a "CAREFIRST MD BCBS-WMG" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9801151 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CA479677 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2108660 . This is a "HIGHMARK BLUE SHIELD-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 417879301 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710902655 . This is a "NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 416145 . This is a "UPMC-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102310711 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1583229 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 277217500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30084123 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6314726 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: D0069284 . This is a "MD LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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