Individual
CHRISTOPHER BLAKE BAMBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
920 OLIVER RD, MONROE, LA 71201-5702
(318) 807-6267
(318) 812-6458
Mailing address
130 DESIARD ST STE 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200394
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2133853
—
LA
Enumeration date
10/18/2010
Last updated
06/11/2019
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