Healthcare Provider Details

I. General information

NPI: 1477588648
Provider Name (Legal Business Name): H N AUGENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREENLEAF CT
GRANTS NM
87020-4235
US

IV. Provider business mailing address

101 GREENLEAF CT
GRANTS NM
87020-4235
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-2621
  • Fax:
Mailing address:
  • Phone: 505-287-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2000-138
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: