Provider Demographics
NPI:1649354515
Name:OKPALO, CHRISTIAN N (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:N
Last Name:OKPALO
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 1:1211 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5207
Mailing Address - Country:US
Mailing Address - Phone:361-358-8982
Mailing Address - Fax:361-358-2176
Practice Address - Street 1:1211 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5207
Practice Address - Country:US
Practice Address - Phone:361-358-8982
Practice Address - Fax:361-358-2176
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3417207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0079676OtherBLUE LINK
8H3350OtherPROVIDER
8H3350OtherPROVIDER
8A2084Medicare ID - Type Unspecified