MEDICARE: CHARLES L CHRISTENSEN MD

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	207R00000X	Internal Medicine Physician	MD12776	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801970983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES L CHRISTENSEN MD

Provider Business Mailing Address
First Line	:	2074 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-3372
Country	:	US
Telephone Number	:	541-880-2011
Fax Number	:	541-885-5512

Provider Business Practice Location Address
First Line	:	2074 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-3372
Country	:	US
Telephone Number	:	541-880-2011
Fax Number	:	541-885-5512

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	03/10/2015

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