Provider Demographics
NPI:1376644930
Name:WALSH, CHRISTINE CHOUTEAU (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:CHOUTEAU
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 GORDON COOPER DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-9005
Mailing Address - Country:US
Mailing Address - Phone:405-878-4702
Mailing Address - Fax:405-214-4227
Practice Address - Street 1:2029 GORDON COOPER DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-9005
Practice Address - Country:US
Practice Address - Phone:405-878-4702
Practice Address - Fax:405-214-4227
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1123689Medicaid
OK241426035Medicare ID - Type Unspecified
OK1123689Medicaid