Provider Demographics
NPI:1649343427
Name:DELONG, CHRISTOPHER J (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:DELONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74362-0278
Mailing Address - Country:US
Mailing Address - Phone:918-824-6474
Mailing Address - Fax:918-824-6316
Practice Address - Street 1:111 N BAILEY ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4201
Practice Address - Country:US
Practice Address - Phone:918-824-6474
Practice Address - Fax:918-824-6316
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100118840AMedicaid
OKG37001501OtherMEDICARE PIN
OK100700040EMedicaid
OK930013792Medicare PIN
OKG001501005Medicare PIN
OKG37001501OtherMEDICARE PIN