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General NPI Number Information
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NPI Number | 1134252851
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Entity Type | Individual
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Provider Name | JONATHAN CLARK CRIST M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 2875 NE STUCKI AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-5806
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Country | US
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Telephone | 971-310-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 NE STUCKI AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-5806
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Country | US
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Telephone | 971-310-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | MD28274
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6604923-8905
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License Number State | UT
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