Provider Demographics
NPI:1124038518
Name:CHRISTIAN-REED, MARY MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:CHRISTIAN-REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9306 S TOLEDO CT
Mailing Address - Street 2:SUITE #100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2746
Mailing Address - Country:US
Mailing Address - Phone:918-494-0400
Mailing Address - Fax:918-494-0405
Practice Address - Street 1:9306 S TOLEDO CT
Practice Address - Street 2:SUITE #100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2746
Practice Address - Country:US
Practice Address - Phone:918-494-0400
Practice Address - Fax:918-494-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23102207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200167450AMedicaid
37D1014917OtherCLIA
37D1014917OtherCLIA
OKH08397Medicare UPIN