Provider Demographics
NPI:1134224371
Name:AUSTIN, ROGER LEE (PA)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1985 TATE BLVD SE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1498
Mailing Address - Country:US
Mailing Address - Phone:828-328-5500
Mailing Address - Fax:828-485-2517
Practice Address - Street 1:1985 TATE BLVD SE
Practice Address - Street 2:SUITE 600
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1498
Practice Address - Country:US
Practice Address - Phone:828-328-5500
Practice Address - Fax:828-485-2517
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19642OtherBC
NC8919642Medicaid
S99158Medicare UPIN
NC19642OtherBC