Provider Demographics
NPI:1134194376
Name:CHRISTIE, DAVID B (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1050 SW 3RD AVE
Mailing Address - Street 2:STE. #2200
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2193
Mailing Address - Country:US
Mailing Address - Phone:541-881-1300
Mailing Address - Fax:541-889-4321
Practice Address - Street 1:1050 SW 3RD AVE
Practice Address - Street 2:STE. #2200
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2193
Practice Address - Country:US
Practice Address - Phone:541-881-1300
Practice Address - Fax:541-889-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21582207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR092608Medicaid
ID804305000Medicaid
OR092608Medicaid
F34973Medicare UPIN