MEDICARE: AUSTIN REGAL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	OS0003411	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00204932	OTHER		RR MCR
3	81899	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1518934850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN REGAL DO

Provider Business Mailing Address
First Line	:	1425 FOXFIRE DR
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-3010
Country	:	US
Telephone Number	:	407-889-2930
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N ALEXANDER ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4303
Country	:	US
Telephone Number	:	813-757-1290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	05/14/2008

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Directions to “ AUSTIN REGAL DO” Practice Location

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