Provider Demographics
NPI:1457374936
Name:DAVIS, CHRIS MYRON (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:MYRON
Last Name:DAVIS
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 1:3433 NW 56TH ST
Mailing Address - Street 2:SUITE 740
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4461
Mailing Address - Country:US
Mailing Address - Phone:405-948-0640
Mailing Address - Fax:405-948-1753
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:SUITE 740
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4461
Practice Address - Country:US
Practice Address - Phone:405-948-0640
Practice Address - Fax:405-948-1753
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21359208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100215860AMedicaid
OKG26814Medicare UPIN