Healthcare Provider Details

I. General information

NPI: 1053677823
Provider Name (Legal Business Name): TOM AUGUSTINE JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

PO BOX 527
LARKSPUR CA
94977-0527
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7100
  • Fax: 903-787-5854
Mailing address:
  • Phone: 415-927-4070
  • Fax: 903-566-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA129286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: