Provider Demographics
NPI:1487608246
Name:MAWN, CHRISTOPHER BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:MAWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:STE 435
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1704
Mailing Address - Country:US
Mailing Address - Phone:720-321-8410
Mailing Address - Fax:720-321-8411
Practice Address - Street 1:11700 W 2ND PL
Practice Address - Street 2:STE 435
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1704
Practice Address - Country:US
Practice Address - Phone:720-321-8410
Practice Address - Fax:720-321-8411
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101050521174400000X
CO50994207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA460076OtherANTHEM BC/BS #
VA006503209Medicaid
CO55079768Medicaid
COP01078922OtherMCR RAILROAD
VA040016845OtherMEDICARE RR #
CO55079768Medicaid
VAF86201Medicare UPIN