MEDICARE: DR. JEFFREY CHARLES CHRISTENSON 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	174400000X	Specialist	MD00035682	WA

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	:	1932162872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CHARLES CHRISTENSON MD

Provider Business Mailing Address
First Line	:	500 LILLY RD NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5197
Country	:	US
Telephone Number	:	360-413-8272
Fax Number	:	360-413-8878

Provider Business Practice Location Address
First Line	:	500 LILLY RD NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5197
Country	:	US
Telephone Number	:	360-413-8272
Fax Number	:	360-413-8878

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	05/03/2021

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