Provider Demographics
NPI:1750918272
Name:GILLETTE, AUSTIN JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:JEFFREY
Last Name:GILLETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:230 VILLAGE COMMONS DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-4545
Practice Address - Country:US
Practice Address - Phone:904-940-1441
Practice Address - Fax:904-390-7463
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS19546207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine