MEDICARE: OREGON COAST NEUROLOGY CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician		OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114049640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON COAST NEUROLOGY CLINIC

Provider Business Mailing Address
First Line	:	1925 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-267-0330
Fax Number	:	541-267-0265

Provider Business Practice Location Address
First Line	:	1925 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-267-0330
Fax Number	:	541-267-0265

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LINDA L BUFTON
Credential	:	M.D.
Telephone Number	:	541-267-0330

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	10/05/2007

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