MEDICARE: DR. AUGUSTINE KANEBI MABATAH 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
1	207W00000X	Ophthalmology Physician	J1540	TX

General Provider Information

NPI Number	:	1508968017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUSTINE KANEBI MABATAH M.D.

Provider Business Mailing Address
First Line	:	8300 HOMESTEAD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-2145
Country	:	US
Telephone Number	:	713-635-5177
Fax Number	:	713-631-8242

Provider Business Practice Location Address
First Line	:	8300 HOMESTEAD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-2145
Country	:	US
Telephone Number	:	713-635-5177
Fax Number	:	713-631-8242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	07/08/2007

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