Provider Demographics
NPI:1225062516
Name:HEBERTSON, CHRISTOPHER FIFE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:FIFE
Last Name:HEBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4502 E 41ST ST STE 2J12
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2536
Mailing Address - Country:US
Mailing Address - Phone:918-660-3400
Mailing Address - Fax:918-660-3410
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4334
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN41127208000000X
IL036.119839208000000X
OK23479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI61397Medicare UPIN