Organization
EDGAR MAEYENS JR MD PC
Active
Other names
Park Avenue Dermatology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR MAEYENS JR. MD (DOCTOR)
(541) 267-7543
Entity
Organization
Contact information
Practice address
375 PARK AVE, SUITE 5, COOS BAY, OR 97420-2244
(541) 267-7543
(541) 267-2076
Mailing address
375 PARK AVE, SUITE 5, COOS BAY, OR 97420-2244
(541) 267-7543
(541) 267-2076
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD08528
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009894000
BLUE CROSS ID #
OR
Enumeration date
11/02/2006
Last updated
06/17/2008
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