Provider Demographics
NPI:1538361795
Name:FEDOR, CHRISTOPHER J (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:FEDOR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9600 BROADWAY EXT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7408
Mailing Address - Country:US
Mailing Address - Phone:405-230-9575
Mailing Address - Fax:405-230-9585
Practice Address - Street 1:MCBRIDE CLINIC, INC.
Practice Address - Street 2:815 NW 12TH
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103
Practice Address - Country:US
Practice Address - Phone:405-230-9575
Practice Address - Fax:405-228-2569
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK426246Z00000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other