MEDICARE: JONATHAN CLARK CRIST M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	MD28274	OR
2	207Q00000X	Family Medicine Physician	6604923-8905	UT

General Provider Information

NPI Number	:	1134252851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN CLARK CRIST M.D.

Provider Business Mailing Address
First Line	:	2875 NE STUCKI AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5806
Country	:	US
Telephone Number	:	971-310-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 NE STUCKI AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5806
Country	:	US
Telephone Number	:	971-310-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/16/2026

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