Provider Demographics
NPI:1194837757
Name:HALL, K. CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:K.
Middle Name:CHRISTOPHER
Last Name:HALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:KEITH
Other - Middle Name:CHRISTOPHER
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3217 NE 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2618
Mailing Address - Country:US
Mailing Address - Phone:503-288-1164
Mailing Address - Fax:
Practice Address - Street 1:4855 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3460
Practice Address - Country:US
Practice Address - Phone:503-643-7565
Practice Address - Fax:503-626-4418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR PA 00331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant