Provider Demographics
NPI:1124060306
Name:TRAINER, AUDREY T (DO)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:T
Last Name:TRAINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2505
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-2505
Mailing Address - Country:US
Mailing Address - Phone:888-828-3198
Mailing Address - Fax:
Practice Address - Street 1:665 WINTER ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3919
Practice Address - Country:US
Practice Address - Phone:503-561-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO24811207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8398554Medicaid
G09751OtherGROUP HEALTH
274975OtherMARION POLK CHP
A065OtherCHAMPUS
P00779894OtherRR MEDICARE
CAXYP200908Medicaid
8938592OtherWA CRIME VICTIMS
015388000OtherBCBS
0187365OtherWA L&I
OR274975Medicaid
G09751OtherPROVIDENCE
CAXYP200908Medicaid
P00206417Medicare PIN
274975OtherMARION POLK CHP
R118148Medicare PIN