Provider Demographics
NPI:1689630949
Name:AUGSPURGER, MARK EMERSON (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EMERSON
Last Name:AUGSPURGER
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:PO BOX 45278
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32232-5278
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-393-7603
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5469
Practice Address - Country:US
Practice Address - Phone:904-271-6890
Practice Address - Fax:904-271-6695
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME869392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01349088OtherRR MEDICARE
FL273689600Medicaid
FL278718100Medicaid
FL78704MMedicare PIN
FL78704NMedicare PIN
FL273689600Medicaid
FL78704WMedicare PIN
FLCT325YMedicare PIN
FL78704SMedicare PIN
FL78704IMedicare PIN
GA92BBFVSMedicare PIN
FLH87143Medicare UPIN
FL278718100Medicaid
FL78704OMedicare PIN
FL78704HMedicare PIN
FL78704RMedicare PIN