Provider Demographics
NPI:1477510709
Name:AGIN, BRENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:J
Last Name:AGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26212 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3580
Mailing Address - Country:US
Mailing Address - Phone:727-230-1438
Mailing Address - Fax:727-230-1437
Practice Address - Street 1:26212 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3580
Practice Address - Country:US
Practice Address - Phone:727-230-1438
Practice Address - Fax:727-230-1437
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME83513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2629691000Medicaid
FL262969100Medicaid
FLE6495WMedicare UPIN
FL262969100Medicaid