Provider Demographics
NPI:1659353704
Name:FRIESS, C CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:CHRISTIAN
Last Name:FRIESS
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 1:2450 NE MARY ROSE PL
Mailing Address - Street 2:STE 120
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7132
Mailing Address - Country:US
Mailing Address - Phone:541-382-3100
Mailing Address - Fax:541-312-7050
Practice Address - Street 1:2450 NE MARY ROSE PL
Practice Address - Street 2:STE 120
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7132
Practice Address - Country:US
Practice Address - Phone:541-382-3100
Practice Address - Fax:541-312-7050
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08950207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR055041Medicaid
D99972Medicare UPIN
OR055041Medicaid