Healthcare Provider Details

I. General information

NPI: 1619961943
Provider Name (Legal Business Name): CHRIS L STURCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 CHUCKWA DR SUITE 500
DURANT OK
74701-2151
US

IV. Provider business mailing address

1727 CHUCKWA DR SUITE 500
DURANT OK
74701-2151
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-8100
  • Fax: 580-924-8105
Mailing address:
  • Phone: 580-924-8100
  • Fax: 580-924-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19094
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: