Provider Demographics
NPI:1306062005
Name:KEYVAN ABTIN, MD, P.C.
Entity type:Organization
Organization Name:KEYVAN ABTIN, MD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TO DR. KEYVAN ABTIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-924-2444
Mailing Address - Street 1:PO BOX 10605
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2605
Mailing Address - Country:US
Mailing Address - Phone:503-924-2444
Mailing Address - Fax:
Practice Address - Street 1:527 SE BASELINE ST
Practice Address - Street 2:# G
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:503-924-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288527Medicaid
ORH24001Medicare UPIN
ORR120291Medicare PIN