=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689648743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL G. CHRISTOPHER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 10/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1805 27TH ST
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-354-5000
-----------------------------------------------------
Fax | 740-353-4759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5518 NW WILFRED DR
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73505-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-581-1208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | 35-04-4243-C
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------