Provider Demographics
NPI:1477795458
Name:OSTERBERG, EDWARD CHARLES III (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CHARLES
Last Name:OSTERBERG
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1970
Mailing Address - Fax:512-407-9010
Practice Address - Street 1:608 RADAM LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1172
Practice Address - Country:US
Practice Address - Phone:512-443-5988
Practice Address - Fax:512-443-5055
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2024-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXQ9222208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365214101Medicaid
TX365214101Medicaid