Provider Demographics
NPI:1104849140
Name:AUSTIN, JEREMY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ROBERT
Last Name:AUSTIN
Suffix:
Gender:M
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 661972
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1972
Mailing Address - Country:US
Mailing Address - Phone:530-410-6283
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1093 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3811
Practice Address - Country:US
Practice Address - Phone:530-410-6283
Practice Address - Fax:530-221-3912
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABA7508659OtherDEA
CA00A745512Medicare PIN
CABA7508659OtherDEA