MEDICARE: DR. EDWIN NEAL AUSTIN MD

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	208200000X	Plastic Surgery Physician	19875	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	:	1669479978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN NEAL AUSTIN MD

Provider Business Mailing Address
First Line	:	875 OAK ST SE
Second Line	:	SUITE 4060
City	:	SALEM
State	:	OR
Zip	:	97301-3975
Country	:	US
Telephone Number	:	503-561-7000
Fax Number	:	503-375-2646

Provider Business Practice Location Address
First Line	:	875 OAK ST SE
Second Line	:	SUITE 4060
City	:	SALEM
State	:	OR
Zip	:	97301-3975
Country	:	US
Telephone Number	:	503-391-7001
Fax Number	:	503-391-6858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	04/17/2019

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