Provider Demographics
NPI:1982677449
Name:DANIELSON, CHRISTA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
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 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3299 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3721
Practice Address - Country:US
Practice Address - Phone:541-342-3338
Practice Address - Fax:541-349-7129
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR084074Medicaid
ORR08WFBFRLMedicare PIN
E27791Medicare UPIN
OR084074Medicaid