Provider Demographics
NPI:1689635245
Name:CHRISTENSEN, EDWIN DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:DALE
Last Name:CHRISTENSEN
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 1:1325 MCFARLAND BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3275
Mailing Address - Country:US
Mailing Address - Phone:205-462-3334
Mailing Address - Fax:
Practice Address - Street 1:1325 MCFARLAND BLVD STE 204
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3275
Practice Address - Country:US
Practice Address - Phone:205-462-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939446Medicaid
AL051536986OtherBC/BS OF ALABAMA
ALP00373792OtherMEDICARE RAILROAD CARRIER
AL511-11742OtherBCBS OF ALABAMA
ALP00373792OtherMEDICARE RAILROAD CARRIER
ALH53736Medicare UPIN