Provider Demographics
NPI:1861631954
Name:AUSTIN, DONALD RAY
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVENDELL DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9188
Mailing Address - Country:US
Mailing Address - Phone:501-316-1255
Mailing Address - Fax:
Practice Address - Street 1:100 RIVENDELL DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-9188
Practice Address - Country:US
Practice Address - Phone:501-316-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator