Individual
DR. CHRISTOPHER DANIEL FEDORUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18951 N MEMORIAL DR, HUMBLE, TX 77338-4217
(281) 540-6453
(281) 540-7393
Mailing address
33910 THOUSAND OAK BLVD, MAGNOLIA, TX 77354-6268
(281) 259-7286
(281) 259-7286
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M0719
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173969001
—
TX
05
—
173969002
—
TX
05
—
173969003
—
TX
05
—
173969005
—
TX
01
—
8AC843
BCBSTX PROVIDER NO
TX
Enumeration date
08/17/2006
Last updated
07/02/2009
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