Provider Demographics
NPI:1811997265
Name:BOZARTH, CHRISTOPHER H (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:BOZARTH
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 1:230 N MIDWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4321
Mailing Address - Country:US
Mailing Address - Phone:405-737-8455
Mailing Address - Fax:405-739-8707
Practice Address - Street 1:230 N MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4321
Practice Address - Country:US
Practice Address - Phone:405-737-8455
Practice Address - Fax:405-739-8707
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK195052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK247235402Medicare PIN
OKP00690633Medicare PIN
OK920007392Medicare PIN