Provider Demographics
NPI:1437295128
Name:BOREN, CHRIS RUSSELL
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:RUSSELL
Last Name:BOREN
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 1:2020 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-1629
Mailing Address - Country:US
Mailing Address - Phone:405-227-9405
Mailing Address - Fax:
Practice Address - Street 1:2020 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1629
Practice Address - Country:US
Practice Address - Phone:405-227-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist