Provider Demographics
NPI:1891738332
Name:AUSTIN, DOUGLAS JOHN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOHN
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
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 70368
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0120
Mailing Address - Country:US
Mailing Address - Phone:541-485-2777
Mailing Address - Fax:541-246-2353
Practice Address - Street 1:590 COUNTRY CLUB PKWY
Practice Address - Street 2:STE. A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6025
Practice Address - Country:US
Practice Address - Phone:541-485-2777
Practice Address - Fax:541-246-2353
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20456207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150190Medicaid
ORR0000WCJNMMedicare PIN
OR046WCJNMAMedicare ID - Type Unspecified
OR150190Medicaid