Provider Demographics
NPI:1114049640
Name:OREGON COAST NEUROLOGY CLINIC
Entity Type:Organization
Organization Name:OREGON COAST NEUROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUFTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-267-0330
Mailing Address - Street 1:1925 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2040
Mailing Address - Country:US
Mailing Address - Phone:541-267-0330
Mailing Address - Fax:541-267-0265
Practice Address - Street 1:1925 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2040
Practice Address - Country:US
Practice Address - Phone:541-267-0330
Practice Address - Fax:541-267-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240162Medicaid
OR240162Medicaid