Healthcare Provider Details

I. General information

NPI: 1689667560
Provider Name (Legal Business Name): CHRISTOPHER WRAY EDWARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 SE CLAY ST
DALLAS OR
97338-2865
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 971-612-6100
  • Fax: 971-612-6101
Mailing address:
  • Phone: 877-708-1119
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD13699
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: