Provider Demographics
NPI:1629295209
Name:POKABLA, CHRISTOPHER MARK (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:POKABLA
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 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-259-1673
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:3045 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-381-4664
Practice Address - Fax:901-373-4870
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20320207X00000X, 207XX0005X
TN45413207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45413OtherMEDICAL LICENSE
MS20320OtherMEDICAL LICENSE
TN00775733OtherMEDICARE RR
OH89964OtherMEDICAL LICENSE
TN1516507Medicaid
TN4241859OtherBCBS OF TN
9329389OtherAETNA
TN103I202925Medicare PIN