Provider Demographics
NPI:1619961943
Name:STURCH, CHRIS L (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:L
Last Name:STURCH
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 1:1727 CHUCKWA DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2151
Mailing Address - Country:US
Mailing Address - Phone:580-924-8100
Mailing Address - Fax:580-924-8105
Practice Address - Street 1:1727 CHUCKWA DR
Practice Address - Street 2:SUITE 500
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2151
Practice Address - Country:US
Practice Address - Phone:580-924-8100
Practice Address - Fax:580-924-8105
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100119490BMedicaid
OK248324501Medicare PIN
G28725Medicare UPIN