Provider Demographics
NPI:1316380595
Name:AUGUSTINE, JONATHAN R (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MERCHANT ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-645-9787
Practice Address - Street 1:3248 WESTBOURNE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5140
Practice Address - Country:US
Practice Address - Phone:513-662-3900
Practice Address - Fax:513-662-3933
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH36.003763213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program