Provider Demographics
NPI:1669479978
Name:AUSTIN, EDWIN NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:NEAL
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:SUITE 4060
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3975
Mailing Address - Country:US
Mailing Address - Phone:503-561-7000
Mailing Address - Fax:503-375-2646
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 4060
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-391-7001
Practice Address - Fax:503-391-6858
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR19875208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137849Medicaid
OR104048Medicare PIN
ORF26730Medicare UPIN