Provider Demographics
NPI:1265843791
Name:MOEDER, CHRISTOPHER BARRET (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BARRET
Last Name:MOEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-539-0707
Mailing Address - Fax:940-228-0165
Practice Address - Street 1:2000 BEN MERRITT DR STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3848
Practice Address - Country:US
Practice Address - Phone:940-539-0707
Practice Address - Fax:940-228-0165
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0947208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400620701Medicaid
TX8LP415OtherBCBC