Provider Demographics
NPI:1134158405
Name:AUTIO, SIRPA T (MD)
Entity type:Individual
Prefix:
First Name:SIRPA
Middle Name:T
Last Name:AUTIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIRPA
Other - Middle Name:T
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2452
Mailing Address - Country:US
Mailing Address - Phone:386-586-4280
Mailing Address - Fax:386-586-4286
Practice Address - Street 1:500 N MUNDO
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528-0187
Practice Address - Country:US
Practice Address - Phone:575-759-3291
Practice Address - Fax:575-759-3532
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37301AMedicare PIN
FLI00680Medicare UPIN