MEDICARE: CHRISTOPHER R STURDEVANT PA-C

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	363AM0700X	Medical Physician Assistant	PA00801	OR
2	363AS0400X	Surgical Physician Assistant	PA00801	OR

General Provider Information

NPI Number	:	1396770582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER R STURDEVANT PA-C

Provider Business Mailing Address
First Line	:	825 BENNETT AVE
Second Line	:	STE 2
City	:	MEDFORD
State	:	OR
Zip	:	97504-6715
Country	:	US
Telephone Number	:	541-608-1997
Fax Number	:	541-772-1553

Provider Business Practice Location Address
First Line	:	1801 HWY 99 N
Second Line	:	STE 2
City	:	ASHLAND
State	:	OR
Zip	:	97520-9152
Country	:	US
Telephone Number	:	541-488-4464
Fax Number	:	541-488-3772

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/09/2017

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Directions to “ CHRISTOPHER R STURDEVANT PA-C” Practice Location

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