Provider Demographics
NPI:1194720250
Name:CHRISTENSEN, ALAN L (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:CHRISTENSEN
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 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:907-228-7688
Mailing Address - Fax:907-228-8468
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-228-7688
Practice Address - Fax:907-228-8468
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT172326-1205207V00000X
MS13746207V00000X
KY41260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT73823OtherPEHP
KY7100018700Medicaid
ID806638800OtherIDAHO MEDICAID
UT17232612000001OtherBLUE CROSS BLUE SHIELD
UTQM0000068942OtherALTIUS
ID806638800OtherIDAHO MEDICAID
UTH87666Medicare UPIN
KY7100018700Medicaid