Healthcare Provider Details

I. General information

NPI: 1558494294
Provider Name (Legal Business Name): CHRISTIAN ROBERT DUREN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SKYLINE VILLAGE LOOP S
SALEM OR
97306-9490
US

IV. Provider business mailing address

700 BELLEVUE SEST 290
SALEM OR
97301-3850
US

V. Phone/Fax

Practice location:
  • Phone: 503-391-1110
  • Fax: 503-370-4237
Mailing address:
  • Phone: 503-967-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberPA00323
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00323
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: