MEDICARE: JACQUE ANGERSTEIN, DO, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K7623	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0058PW	OTHER	TX	BCBS OF TEXAS ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386620797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUE ANGERSTEIN, DO, PA

Provider Business Mailing Address
First Line	:	3700 LOST CREEK BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-1461
Country	:	US
Telephone Number	:	512-328-3111
Fax Number	:	512-328-2752

Provider Business Practice Location Address
First Line	:	2765 BEE CAVES RD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-5640
Country	:	US
Telephone Number	:	512-328-3311
Fax Number	:	512-328-2751

Authorized Official
Title or Position	:	DOCTOR
Name	:	JACQUE ANGERSTEIN
Credential	:
Telephone Number	:	512-328-3311

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	06/16/2018

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