Provider Demographics
NPI:1346240272
Name:MEIS, CHRISTINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:MEIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 NW HAWTHORNE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-6008
Mailing Address - Country:US
Mailing Address - Phone:541-471-7056
Mailing Address - Fax:541-474-3201
Practice Address - Street 1:1619 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-6008
Practice Address - Country:US
Practice Address - Phone:541-471-7056
Practice Address - Fax:541-476-6690
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00290213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150343Medicaid
ORU65980Medicare UPIN
OR117951Medicare ID - Type Unspecified