Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0006174 | FL |
NPI | 1508935099 |
---|---|
Provider Name | Mr. Brian J Augustine |
First Address | Wesley Chapel, FL 33543-4251 |
Second Address | Wesley Chapel, FL 33543-4251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T95652 | (02) | FL |