Provider Demographics
NPI:1407334675
Name:THAVER, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:THAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4195 W NEW HAVEN AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1701
Mailing Address - Country:US
Mailing Address - Phone:321-491-2842
Mailing Address - Fax:321-290-9983
Practice Address - Street 1:4195 W NEW HAVEN AVE STE 7
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1701
Practice Address - Country:US
Practice Address - Phone:321-491-2842
Practice Address - Fax:321-290-9983
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151298207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine