Provider Demographics
NPI:1407827553
Name:PLACE, CHRISTOPHER L (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:PLACE
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 1:7501 RIVERSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5056
Mailing Address - Country:US
Mailing Address - Phone:918-710-4200
Mailing Address - Fax:
Practice Address - Street 1:7501 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-710-4200
Practice Address - Fax:918-403-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100082630AMedicaid
OK100082630AMedicaid