Provider Demographics
NPI:1013918267
Name:AUSTIN, JAMES CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHRISTOPHER
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:PEDIATRIC UROLOGY CDW-6
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-4808
Mailing Address - Fax:503-494-4743
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:PEDIATRIC UROLOGY CDW-6
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-4808
Practice Address - Fax:503-494-4743
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34484208800000X
ORMD293512088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44934OtherWELLMARK BC/BS
IA0260976Medicaid
H58032Medicare UPIN
IA340019959Medicare PIN
IAI5993Medicare PIN