Provider Demographics
NPI:1467508994
Name:AUGUSTINE, MARTIN MV (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:MV
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:MV
Other - Last Name:AUGUSTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-590-5582
Mailing Address - Fax:214-590-1825
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-590-5582
Practice Address - Fax:214-590-1825
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ15464208600000X
MDT3530208600000X
TXQ15642086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery