EDGAR MAEYENS JR MD PC NPI 1043398159

NPI Information

  • NPI: 1043398159
  • Provider Name: EDGAR MAEYENS JR MD PC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • Doing Business As: PARK AVENUE DERMATOLOGY CLINIC
  • Address: 375 PARK AVE
    SUITE 5
    COOS BAY, OR
    ZIP 97420
  • Phone: (541) 267-7543

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NPI Details

EDGAR MAEYENS JR MD PC is a specialist in Coos Bay, OR. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. EDGAR MAEYENS JR MD PC NPI is 1043398159. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Park Avenue Dermatology Clinic.

The provider's business location address is:

375 PARK AVE
SUITE 5
COOS BAY, OR
ZIP 97420-244
Phone: (541) 267-7543
Fax: (541) 267-2076

The provider's authorized official is Edgar Maeyens .
The authorized official title is Doctor and has the following contact phone number (541) 267-7543.

The enumeration date for this NPI number is 11/2/2006 and was last updated on 6/17/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistMD08528OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1C93204MEDICARE UPINOREGON
2009894000OTHEROREGONBLUE CROSS ID #
3R112711MEDICARE PINOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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