Basic Information
| Provider Information | |||||||||
| NPI: | 1457945115 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VANNISPEN | ||||||||
| FirstName: | CHRISTIAAN | ||||||||
| MiddleName: | ARNOUD SIMON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | DEPT OF MEDICINE, MCHE-MDX | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109164789 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | DEPT OF MEDICINE, MCHE-MDX | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782347823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109164789 | ||||||||
| FaxNumber: | 2109166654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2021 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | U0452 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | U0452 | TX | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.