Provider Demographics
NPI:1386833408
Name:AVANT, KRISTOPHER R (DO)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:R
Last Name:AVANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 S WALKER AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9475
Mailing Address - Country:US
Mailing Address - Phone:405-632-4468
Mailing Address - Fax:405-619-4487
Practice Address - Street 1:1805 COMMONS CIR STE 100-C
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9519
Practice Address - Country:US
Practice Address - Phone:405-265-0165
Practice Address - Fax:405-265-0897
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4499207X00000X, 207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4499OtherMEDICAL LICENSE
FL14CP2OtherBCBS
FL9515678OtherAETNA
FL2629208OtherCIGNA
FL003734700Medicaid