Edgar Maeyens, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

MD08528 Issued in OR

Practice address

375 Park Ave
Suite 5
Coos Bay, OR 97420-2242

Phone

(541) 267-7543

Fax

(541) 267-2076

NPI assigned

Nov 7, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edgar Maeyens Jr MD PC

  dba Park Avenue Dermatology Clinic

  • Specialist
  • Coos Bay, OR
  • NPI 1043398159
  Authorized official Same address or phone

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512432000000",
    "number": "1871574947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 13TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022541",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435"
        },
        {
            "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": "974202242",
            "telephone_number": "541-267-7543",
            "fax_number": "541-267-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAEYENS",
        "first_name": "EDGAR",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2017-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "OR",
            "license": "MD08528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kamy Lutz
• Stephanie Lyon, PHARM.D
• Leeann Marie Macdonald, LMT
• Heather Renee Maclean, RN, NMNP - PP
• James Alan Maddox, M.D.
• Tiffany Mahikoa, RDH, EPDH
• Steve M Maland, CRNA
• Deborah B Manders, L.AC.
• Calvin Edwin Mang, D.C.
• Jessica Jean Manske

• MOHS-Micrographic Surgery Physician in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• MOHS-Micrographic Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; 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.