Provider Demographics
NPI:1962464602
Name:AUEN, EDWARD LEONARD (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEONARD
Last Name:AUEN
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Gender:M
Credentials:PHD, MD
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Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:STE 122
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2810
Mailing Address - Country:US
Mailing Address - Phone:209-529-2052
Mailing Address - Fax:209-529-0323
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:STE 122
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-529-2052
Practice Address - Fax:209-529-0323
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA50019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF05313Medicare UPIN
CA00A500192Medicare PIN