Provider Demographics
NPI:1568630010
Name:OLIVARES, CHRISTOPHER ROMAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROMAN
Last Name:OLIVARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 WINTER ST SE
Mailing Address - Street 2:DEPERTMENT OF EMERGENCY MEDICINE
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3919
Mailing Address - Country:US
Mailing Address - Phone:801-440-9838
Mailing Address - Fax:
Practice Address - Street 1:665 WINTER ST SE
Practice Address - Street 2:DEPERTMENT OF EMERGENCY MEDICINE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3919
Practice Address - Country:US
Practice Address - Phone:801-440-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6353353-1205207P00000X
ORMD28356207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine