Provider Demographics
NPI:1134577810
Name:CHRISTENSEN, ERIC CLAYTON (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:CLAYTON
Last Name:CHRISTENSEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 4500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2171
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:2971 WILLOW CREEK RD BLDG 34
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-4142
Practice Address - Country:US
Practice Address - Phone:928-277-8088
Practice Address - Fax:928-460-5280
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD193733207R00000X
AZ64482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ00214136OtherRAILROAD MEDICARE
AZ107409Medicaid