Provider Demographics
NPI:1396770582
Name:STURDEVANT, CHRISTOPHER R (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:STURDEVANT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 BENNETT AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6715
Mailing Address - Country:US
Mailing Address - Phone:541-608-1997
Mailing Address - Fax:541-772-1553
Practice Address - Street 1:1801 HWY 99 N
Practice Address - Street 2:STE 2
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9152
Practice Address - Country:US
Practice Address - Phone:541-488-4464
Practice Address - Fax:541-488-3772
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00801363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P38123Medicare UPIN