Provider Demographics
NPI:1245394022
Name:PETERSON, CHRISTINA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15259 SE 82ND DR
Mailing Address - Street 2:201B
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6609
Mailing Address - Country:US
Mailing Address - Phone:503-656-9844
Mailing Address - Fax:503-656-3120
Practice Address - Street 1:15259 SE 82ND DR
Practice Address - Street 2:201B
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6609
Practice Address - Country:US
Practice Address - Phone:503-656-9844
Practice Address - Fax:503-656-3120
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD136752084N0400X
AK28392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C93513Medicare UPIN
0000BLCGJMedicare ID - Type Unspecified
0000BHVQBMedicare ID - Type Unspecified