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NPI Code Detail

MEDICARE: DR. EDWIN CHARLES AUGUSTAT M.D.

MEDICARE:  DR. EDWIN CHARLES AUGUSTAT  M.D.
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
1207W00000XOphthalmology PhysicianD6229TX

General Provider Information

NPI Number : 1447236708
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWIN CHARLES AUGUSTAT M.D.
Provider Business Mailing Address
First Line : 909 9TH AVE
Second Line : STE 401
City : FORT WORTH
State : TX
Zip : 76104-3903
Country : US
Telephone Number : 817-338-4183
Fax Number : 817-338-0938
Provider Business Practice Location Address
First Line : 909 9TH AVE
Second Line : STE 401
City : FORT WORTH
State : TX
Zip : 76104-3903
Country : US
Telephone Number : 817-338-4183
Fax Number : 817-338-0938
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 01/04/2008

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Directions to “ DR. EDWIN CHARLES AUGUSTAT M.D.” Practice Location

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