Individual
DR. JOHN M. CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-3293
(212) 263-3522
Mailing address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-3293
(212) 263-3522
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35 123788
OH
207P00000X
Emergency Medicine Physician
ME95727
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
ME 95727
FL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
ME 95727
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BLUE SHIELD OF FL
FL
05
—
PENDING
—
FL
Enumeration date
06/30/2006
Last updated
03/09/2021
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