Provider Demographics
NPI:1568651842
Name:KOFORD, CHRIS (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:KOFORD
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:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-0482
Mailing Address - Country:US
Mailing Address - Phone:502-693-6477
Mailing Address - Fax:502-243-3177
Practice Address - Street 1:3104 BLACKISTON BLVD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9579
Practice Address - Country:US
Practice Address - Phone:502-693-6477
Practice Address - Fax:502-243-3177
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY357812081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64062441Medicaid
KYH80673Medicare UPIN