Provider Demographics
NPI:1558307660
Name:AUSTGEN, THOMAS ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:AUSTGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:AUSTGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1613
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:1370 13TH AVE S
Practice Address - Street 2:SUITE 116
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3206
Practice Address - Country:US
Practice Address - Phone:904-247-3858
Practice Address - Fax:904-247-7079
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95091208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00722976OtherRAILROAD MEDICARE
FL2922220OtherCIGNA
FL48980OtherBLUE CROSS BLUE SHIELD
FL294577OtherAVMED
FL4516825OtherAETNA
FL270661000Medicaid
GA289542326AMedicaid
FL2922220OtherCIGNA
F75771Medicare UPIN