Provider Demographics
NPI:1477583391
Name:SOCKRIDER, CHRISTOPHER SEAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SEAN
Last Name:SOCKRIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4519
Mailing Address - Country:US
Mailing Address - Phone:185-249-5653
Mailing Address - Fax:
Practice Address - Street 1:820 JORDAN ST STE 210
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4519
Practice Address - Country:US
Practice Address - Phone:318-212-3823
Practice Address - Fax:318-212-3887
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487392Medicaid
4F290Medicare ID - Type Unspecified
LA1487392Medicaid