Provider Demographics
NPI:1689667560
Name:EDWARDSON, CHRISTOPHER WRAY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WRAY
Last Name:EDWARDSON
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:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:531 SE CLAY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2865
Practice Address - Country:US
Practice Address - Phone:971-612-6100
Practice Address - Fax:971-612-6101
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286187Medicaid
ORC94303Medicare UPIN
OR108081Medicare ID - Type Unspecified