Provider Demographics
NPI:1407006166
Name:AUGUSTINE V JOSEPH MD PA
Entity Type:Organization
Organization Name:AUGUSTINE V JOSEPH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-290-1558
Mailing Address - Street 1:5200 DAVISSON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5350
Mailing Address - Country:US
Mailing Address - Phone:407-290-1558
Mailing Address - Fax:407-292-8852
Practice Address - Street 1:5200 DAVISSON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5350
Practice Address - Country:US
Practice Address - Phone:407-290-1558
Practice Address - Fax:407-292-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055098100Medicaid
FLE64636Medicare UPIN
FL12658Medicare PIN