Basic Information
| Provider Information | |||||||||
| NPI: | 1518934850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGAL | ||||||||
| FirstName: | AUSTIN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 FOXFIRE DR | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327123010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078892930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 N ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335634303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137571290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS0003411 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 029430600 | 05 | FL | MEDICAID | P00204932 | 01 | RR MCR | OTHER | 81899 | 01 | FL | BCBS | OTHER |