Provider Demographics
NPI:1053744524
Name:SMITH, CHRISTOPHER JASON (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JASON
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NE CIRCLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4256
Mailing Address - Country:US
Mailing Address - Phone:541-286-4742
Mailing Address - Fax:833-450-5933
Practice Address - Street 1:800 NE CIRCLE BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4256
Practice Address - Country:US
Practice Address - Phone:541-286-4742
Practice Address - Fax:833-450-5933
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA164650208VP0000X, 363A00000X, 208VP0014X
ORPA64650208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine