Provider Demographics
NPI:1811348063
Name:THOMPSON, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 S PEORIA AVE
Mailing Address - Street 2:APT #437
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3658
Mailing Address - Country:US
Mailing Address - Phone:918-902-8557
Mailing Address - Fax:405-895-7544
Practice Address - Street 1:9210 S WESTERN AVE
Practice Address - Street 2:STE A-21
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4982
Practice Address - Country:US
Practice Address - Phone:918-902-8557
Practice Address - Fax:405-895-7544
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist