Provider Demographics
NPI:1447236708
Name:AUGUSTAT, EDWIN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:CHARLES
Last Name:AUGUSTAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:909 9TH AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-338-4183
Mailing Address - Fax:817-338-0938
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:STE 401
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-338-4183
Practice Address - Fax:817-338-0938
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD6229207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86370FMedicare PIN
TXB21001Medicare UPIN