Provider Demographics
NPI:1669483566
Name:AUSTEN, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:AUSTEN
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 1:3237 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1312
Mailing Address - Country:US
Mailing Address - Phone:740-450-3400
Mailing Address - Fax:740-450-3420
Practice Address - Street 1:3237 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1312
Practice Address - Country:US
Practice Address - Phone:740-450-3400
Practice Address - Fax:740-450-3420
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35-06-2150A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM62150JOtherHEALTH PLAN
OH000000122289OtherANTHEM
OH3100138OtherUHC
OH130018567OtherRR MEDICARE
OH0141760Medicaid
OHAU0783306Medicare ID - Type UnspecifiedZANES OHIO M/C #
OH0141760Medicaid
OHAU0783305Medicare ID - Type UnspecifiedCAMB OFC MC #