Provider Demographics
NPI:1548294580
Name:LAHR, CHRISTOPHER
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:LAHR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-925-6805
Mailing Address - Fax:601-926-4978
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-925-6805
Practice Address - Fax:601-926-4978
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19900208600000X
SC14371208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL157111Medicaid
LA2167413Medicaid
MS06507067Medicaid
MSP00704066OtherRAILROAD MEDICARE
SC183142Medicaid
LA2167413Medicaid
MSP00704066OtherRAILROAD MEDICARE
AL157111Medicaid
MS302I025428Medicare UPIN