Provider Demographics
NPI:1841611027
Name:JESSEN, CHRISTOPHER FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:FREDERIC
Last Name:JESSEN
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 1:5475 E SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6858
Mailing Address - Country:US
Mailing Address - Phone:208-777-7109
Mailing Address - Fax:
Practice Address - Street 1:5475 E SHORELINE DR
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6858
Practice Address - Country:US
Practice Address - Phone:208-777-7109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-14
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7749207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery