Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | Q15464 | TX |
N | 208600000X | Surgeon | Q15464 | TX |
N | 208200000X | Surgeon | T3530 | MD |
N | 208600000X | Surgeon | T3530 | MD |
Y | 2086X0206X | Surgical Oncologist | Q1564 | TX |
NPI | 1467508994 |
---|---|
Provider Name | Dr. Martin M.v. Augustine |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 07/09/2017 |