Provider Demographics
NPI:1528057593
Name:FORD, CHRISTINA M (MD)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-5545
Mailing Address - Fax:
Practice Address - Street 1:2275 NE DOCTORS DR STE 6
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6092
Practice Address - Country:US
Practice Address - Phone:541-706-4250
Practice Address - Fax:541-706-7794
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297540Medicaid
ORH97135Medicare UPIN
ORR181911Medicare PIN
OR297540Medicaid