Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 34484 | IA |
Y | 2088P0231X | Pediatric Urologist | MD29351 | OR |
NPI | 1013918267 |
---|---|
Provider Name | Dr. James Christopher Austin |
First Address | Portland, OR 97239 |
Second Address | Portland, OR 97239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0260976 | (05) | IA |
44934 | WELLMARK BC/BS (01) | IA |
H58032 | (02) |