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General NPI Number Information
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NPI Number | 1497022834
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Entity Type | Organization
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Legal Business Name | MUDDAMALLE J AUGUSTINE MD PA
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 912 WRIGHT ST SUITE E
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City | ARLINGTON
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State | TX
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Zip | 76012-4759
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Country | US
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Telephone | 817-861-6464
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Fax | 817-861-7900
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Provider Business Mailing Address
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Address Line | 912 WRIGHT ST SUITE E
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City | ARLINGTON
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State | TX
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Zip | 76012-4759
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Country | US
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Telephone | 817-861-6464
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Fax | 817-861-7900
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUDDAMALLE J AUGUSTINE
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Credential | MD
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Telephone | 817-861-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G6261
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License Number State | TX
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