Basic Information
| Provider Information | |||||||||
| NPI: | 1629029079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLAXEL | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3375 SW TERWILLIGER BLVD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034183352 | ||||||||
| FaxNumber: | 5034947233 | ||||||||
| Practice Location | |||||||||
| Address1: | 3375 SW TERWILLIGER BLVD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034183352 | ||||||||
| FaxNumber: | 5034947233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 12/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD16026 | OR | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | MD16026 | OR | Y |
ID Information
| ID | Type | State | Issuer | Description | 275386 | 05 | OR | MEDICAID |