Basic Information
| Provider Information | |||||||||
| NPI: | 1710902655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBRUN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 ORANGE TREE LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923744587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095571600 | ||||||||
| FaxNumber: | 9095571732 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 BROCKTON AVE STE 306 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925014027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519772460 | ||||||||
| FaxNumber: | 9519772444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD422624 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | D0069284 | MD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | MD422624 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | C172147 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207X00000X | C172147 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 01 | FL | AVMED | OTHER | 952901 | 01 | MD | CAREFIRST MD BCBS-WMG | OTHER | 9801151 | 01 | FL | AETNA | OTHER | CA479677 | 05 | CA | MEDICAID | 2108660 | 01 | PA | HIGHMARK BLUE SHIELD-WMG | OTHER | 417879301 | 05 | MD | MEDICAID | 1710902655 | 01 | MD | NPI | OTHER | 416145 | 01 | PA | UPMC-WMG | OTHER | 102310711 | 05 | PA | MEDICAID | 1583229 | 01 | PA | GATEWAY-WMG | OTHER | 277217500 | 05 | FL | MEDICAID | 30084123 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 6314726 | 01 | FL | CIGNA | OTHER | D0069284 | 01 | MD | MD LICENSE | OTHER | PENDING | 01 | FL | BC/BS | OTHER |