Provider Demographics
NPI:1891049706
Name:MULDER, CHRIS P (LMT 17840)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:P
Last Name:MULDER
Suffix:
Gender:M
Credentials:LMT 17840
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 BREWER AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1915
Mailing Address - Country:US
Mailing Address - Phone:210-621-5589
Mailing Address - Fax:
Practice Address - Street 1:1692 BREWER AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1915
Practice Address - Country:US
Practice Address - Phone:210-621-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17840171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor