Provider Demographics
NPI:1689648743
Name:CHRISTOPHER, SAMUEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:G
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:G
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, LLC
Mailing Address - Street 1:5518 NW WILFRED DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3129
Mailing Address - Country:US
Mailing Address - Phone:580-581-1208
Mailing Address - Fax:
Practice Address - Street 1:1805 27TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2640
Practice Address - Country:US
Practice Address - Phone:740-354-5000
Practice Address - Fax:740-353-4759
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-4243-C204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0508856Medicaid
OHC03773Medicare UPIN
OH0508856Medicaid