Healthcare Provider Details

I. General information

NPI: 1316380595
Provider Name (Legal Business Name): JONATHAN R AUGUSTINE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 WESTBOURNE DR SUITE 1
CINCINNATI OH
45248-5140
US

IV. Provider business mailing address

25 MERCHANT ST STE 220
CINCINNATI OH
45246-3740
US

V. Phone/Fax

Practice location:
  • Phone: 513-662-3900
  • Fax: 513-662-3933
Mailing address:
  • Phone: 513-533-1199
  • Fax: 513-645-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.003763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: