Provider Demographics
NPI:1629282389
Name:MANUS, CHRISTOPHER MARK (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:MANUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12697 E 51ST ST SOUTH
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT.
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-6236
Mailing Address - Country:US
Mailing Address - Phone:918-499-2109
Mailing Address - Fax:918-499-2109
Practice Address - Street 1:3470 E FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2406
Practice Address - Country:US
Practice Address - Phone:918-331-1760
Practice Address - Fax:918-331-1445
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK27660207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK331740YV6NMedicare PIN