Basic Information
| Provider Information | |||||||||
| NPI: | 1487740809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEHAN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 MEDICAL PKWY | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124540392 | ||||||||
| FaxNumber: | 5124541233 | ||||||||
| Practice Location | |||||||||
| Address1: | 3705 MEDICAL PKWY | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124540392 | ||||||||
| FaxNumber: | 5124541233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 02/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | G8075 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 116381801 | 05 | TX | MEDICAID | 804490 | 01 | TX | BCBS | OTHER |