Provider Demographics
NPI:1144202052
Name:AUGUSTIN, JEAN MAX HERVE (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MAX HERVE
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38152 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1380
Mailing Address - Country:US
Mailing Address - Phone:813-355-4373
Mailing Address - Fax:813-355-4540
Practice Address - Street 1:38152 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1380
Practice Address - Country:US
Practice Address - Phone:813-355-4373
Practice Address - Fax:813-355-4540
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90823207Q00000X
MS26141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03239557Medicaid
H92730Medicare UPIN