Provider Demographics
NPI:1164412755
Name:SEALS, CHRISTINE MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MICHELLE
Last Name:SEALS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2504 NW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5510
Mailing Address - Country:US
Mailing Address - Phone:541-957-0111
Mailing Address - Fax:541-957-0333
Practice Address - Street 1:2504 NW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-5510
Practice Address - Country:US
Practice Address - Phone:541-957-0111
Practice Address - Fax:541-957-0333
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080159825OtherRAILROAD MEDICARE
ORMD22714OtherSTATE LICENSE NUMBER
ORMD22714OtherSTATE LICENSE NUMBER
OR080159825OtherRAILROAD MEDICARE
ORBS5380972OtherDEA NUMBER