Provider Demographics
NPI:1861442550
Name:CHRISTENSEN, ERIK DEAN (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:DEAN
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 1:4451 S 2700 W
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-8601
Mailing Address - Country:US
Mailing Address - Phone:801-816-3850
Mailing Address - Fax:801-964-1240
Practice Address - Street 1:4451 S 2700 W
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-8601
Practice Address - Country:US
Practice Address - Phone:801-816-3850
Practice Address - Fax:801-964-1240
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23071207ZF0201X, 207ZP0102X
UT315477-1205207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH80437Medicare UPIN