Individual
CHRISTOPHER DANIEL ALSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17356 US HIGHWAY 301 N, STARKE, FL 32091-1619
(904) 982-4113
Mailing address
17356 US HIGHWAY 301 N, STARKE, FL 32091-1619
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
15435
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15435
—
FL
Enumeration date
08/15/2017
Last updated
08/15/2017
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