Basic Information
| Provider Information | |||||||||
| NPI: | 1558757997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZEVEDO | ||||||||
| FirstName: | KRISTOPHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 931 CHEVY WAY | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416903555 | ||||||||
| FaxNumber: | 5418422212 | ||||||||
| Practice Location | |||||||||
| Address1: | 4940 HAMRICK RD | ||||||||
| Address2: | |||||||||
| City: | CENTRAL POINT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975023072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416903600 | ||||||||
| FaxNumber: | 5416643735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2015 | ||||||||
| LastUpdateDate: | 01/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD179559 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.