Healthcare Provider Details

I. General information

NPI: 1043304637
Provider Name (Legal Business Name): BONNIE JEAN AUST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD KAISER SUNNYSIDE MEDICAL OFFICE
CLACKAMAS OR
97015-9764
US

IV. Provider business mailing address

9800 SE SUNNYSIDE RD KAISER PERMANENTE MT SCOTT MEDICAL OFFICE
CLACKAMAS OR
97015-9750
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-2880
  • Fax:
Mailing address:
  • Phone: 503-571-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOR MD20965
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: