Provider Demographics
NPI:1568789675
Name:MANGRUM, CHRISTIAN (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:MANGRUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 W MEMORIAL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1717
Mailing Address - Country:US
Mailing Address - Phone:405-951-4160
Mailing Address - Fax:405-951-4162
Practice Address - Street 1:4345 W MEMORIAL RD STE 110
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1717
Practice Address - Country:US
Practice Address - Phone:405-951-4160
Practice Address - Fax:405-951-4162
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6901207RE0101X
OK5773207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism