Basic Information
| Provider Information | |||||||||
| NPI: | 1902995988 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTY ALLEN BENNETT DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8803 E. 101ST E. AVE | ||||||||
| Address2: | 370 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184926333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8803 S. 101ST E. AVE | ||||||||
| Address2: | 370 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184926333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | CHRISTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9184926333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.