Healthcare Provider Details

I. General information

NPI: 1205879590
Provider Name (Legal Business Name): CHARLES IKE AUSTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

2102 TREASURE HILLS BLVD #3.144.05
HARLINGEN TX
78550-8736
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax: 956-682-0597
Mailing address:
  • Phone: 956-296-1437
  • Fax: 956-296-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3724
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF3724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: