Edgar Maeyens Jr MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD08528 Issued in OR

Legal business name

EDGAR MAEYENS JR MD PC

Practice address

375 Park Ave
Suite 5
Coos Bay, OR 97420-2244

Phone

(541) 267-7543

Fax

(541) 267-2076

NPI assigned

Nov 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edgar Maeyens Jr., MD

Title

Doctor

Phone

(541) 267-7543

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Park Avenue Dermatology Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1043398159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 PARK AVE",
            "address_2": "SUITE 5",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202244",
            "telephone_number": "541-267-7543",
            "fax_number": "541-267-2076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 PARK AVE",
            "address_2": "SUITE 5",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202244",
            "telephone_number": "541-267-7543",
            "fax_number": "541-267-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGAR MAEYENS JR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "MAEYENS",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "541-267-7543",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD08528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID #",
            "identifier": "009894000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Avenue Dermatology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia K Dudas, CFNP
• Audrey M Duke, FNP
• Stephanie Marie Dulian, CRNA
• Early Intervention Early Childhood Special Education
• Benjamin Todd Eastham, M.D.
• Ariel Edwards
• Cynthia Helen Edwards
• Michael S Edwards, RNFA
• Laicee Eichler, CADCII, QMHAI
• Marcas D Ekart

• Specialist in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.