Healthcare Provider Details

I. General information

NPI: 1679377493
Provider Name (Legal Business Name): AUSTIN THOMAS COALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date: 04/08/2025
Reactivation Date: 05/02/2025

III. Provider practice location address

PO BOX 100287
GAINESVILLE FL
32610-0287
US

IV. Provider business mailing address

PO BOX 100287
GAINESVILLE FL
32610-0287
US

V. Phone/Fax

Practice location:
  • Phone: 522-650-9163
  • Fax: 352-265-3292
Mailing address:
  • Phone: 522-650-9163
  • Fax: 352-265-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: