MEDICARE: DR. AUGUSTUS T FAHNBULLEH SR. M.D.

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	174400000X	Specialist

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

General Provider Information

NPI Number	:	1457413775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUSTUS T FAHNBULLEH SR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 941478
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77094-8478
Country	:	US
Telephone Number	:	713-979-0251
Fax Number	:	713-979-0366

Provider Business Practice Location Address
First Line	:	9601 KATY FWY STE 260
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1349
Country	:	US
Telephone Number	:	713-979-0251
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/25/2026

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