Provider Demographics
NPI:1851382220
Name:KNOBBE, CHRIS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:ALAN
Last Name:KNOBBE
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 1:1400 BRYAN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2156
Mailing Address - Country:US
Mailing Address - Phone:580-931-2247
Mailing Address - Fax:580-931-2249
Practice Address - Street 1:1400 BRYAN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2156
Practice Address - Country:US
Practice Address - Phone:580-931-2247
Practice Address - Fax:580-931-2249
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0871207W00000X
OK20422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100203920AMedicaid
TX175548001Medicaid
TX0047MAOtherBCBS GROUP #
TX4107009OtherBLUE LINK #
TX5044251OtherAETNA REFERRAL #
TX8R1770OtherBCBS INDIVIDUAL #
TX030659905Medicaid
TX331087115OtherFEDERAL ID #
OK244508301Medicare ID - Type UnspecifiedOK MEDICARE INDIVIDUAL #
TX00114XMedicare ID - Type UnspecifiedTX MEDICARE GROUP #
TX030659905Medicaid
TXP00155626Medicare ID - Type UnspecifiedPALMETTO INDIVIDUAL #
TX8R1770OtherBCBS INDIVIDUAL #
TX4107009OtherBLUE LINK #
TX331087115OtherFEDERAL ID #