Healthcare Provider Details

I. General information

NPI: 1477795458
Provider Name (Legal Business Name): EDWARD CHARLES OSTERBERG III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 RADAM LN
AUSTIN TX
78745-1172
US

IV. Provider business mailing address

8240 N MOPAC EXPY STE 100
AUSTIN TX
78759-8869
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-5988
  • Fax: 512-443-5055
Mailing address:
  • Phone: 512-687-1970
  • Fax: 512-407-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberQ9222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: