Individual
CHRIS ALBERT PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
875 OAK ST SE, SUITE 5020, SALEM, OR 97301-3975
(503) 226-6321
(503) 227-3422
Mailing address
975 SE SANDY BLVD, SUITE 200, PORTLAND, OR 97214-1308
(503) 963-2846
(503) 963-9505
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00211
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210476
—
OR
05
—
8435877
—
WA
Enumeration date
08/22/2005
Last updated
08/19/2009
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