Provider Demographics
NPI:1760434955
Name:CHRISTIE, BYRON H (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:H
Last Name:CHRISTIE
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 1:3600 NW 138TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2503
Mailing Address - Country:US
Mailing Address - Phone:405-286-4114
Mailing Address - Fax:405-463-0154
Practice Address - Street 1:3600 NW 138TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2503
Practice Address - Country:US
Practice Address - Phone:405-286-4114
Practice Address - Fax:405-463-0154
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK241082085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200039600BMedicaid
OK200039600AMedicaid
OK200039600BMedicaid
OKOK700295Medicare PIN
OK200039600AMedicaid
OKOKAAA2728Medicare PIN
OK239424001Medicare PIN
OKF93241Medicare UPIN
OKP00319354Medicare PIN
OKP01029752Medicare PIN
OK249728207Medicare PIN
OK24C726804Medicare PIN