Provider Demographics
NPI:1750360459
Name:JOSEPH, AUGUSTINE V (MD)
Entity type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:V
Last Name:JOSEPH
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 1:5200 DAVISSON AVE
Mailing Address - Street 2:SUITE A
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:SUITE A
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
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055098100Medicaid
FL12658Medicare PIN
FLE64636Medicare UPIN