Provider Demographics
NPI:1457544264
Name:PRIMIS, AUSTIN (DO)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:PRIMIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W SOVEREIGN PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8071
Mailing Address - Country:US
Mailing Address - Phone:352-527-0068
Mailing Address - Fax:
Practice Address - Street 1:3700 W SOVEREIGN PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8071
Practice Address - Country:US
Practice Address - Phone:352-527-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine