Provider Demographics
NPI:1689646556
Name:CHRISTENSEN, JOHN ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROGER
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:10700 MACARTHUR BLVD
Mailing Address - Street 2:STE 14 B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5298
Mailing Address - Country:US
Mailing Address - Phone:510-563-4300
Mailing Address - Fax:510-563-4381
Practice Address - Street 1:10700 MACARTHUR BLVD
Practice Address - Street 2:STE 14 B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5298
Practice Address - Country:US
Practice Address - Phone:510-563-4300
Practice Address - Fax:510-563-4381
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-01-05
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Provider Licenses
StateLicense IDTaxonomies
CAG39869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A55699Medicare UPIN