Provider Demographics
NPI:1922027770
Name:HATLESTAD, CHRISTOPHER LIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LIEN
Last Name:HATLESTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:LIEN
Other - Last Name:HATLESTAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1221 SE MADISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3890
Mailing Address - Country:US
Mailing Address - Phone:503-212-4488
Mailing Address - Fax:503-212-4495
Practice Address - Street 1:17685 65TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7800
Practice Address - Country:US
Practice Address - Phone:503-747-2021
Practice Address - Fax:503-747-2802
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD24066OtherMEDICAL LICENSE
ORBH2808751OtherDEA
116877Medicare ID - Type Unspecified
ORMD24066OtherMEDICAL LICENSE