Healthcare Provider Details

I. General information

NPI: 1992744056
Provider Name (Legal Business Name): JOHN CHRISTOPHER ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J. CHRIS ANDERSON MD

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/07/2023
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 SE SUNNYSIDE ROAD, SUITE 200
CLACKAMAS OR
97015
US

IV. Provider business mailing address

4744 SE YAMHILL STREET
PORTLAND OR
97215
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-8471
  • Fax:
Mailing address:
  • Phone: 503-475-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24145
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: