Provider Demographics
NPI:1740576305
Name:CHARLES A. AUGUSTUS II, M.D., P.A.
Entity Type:Organization
Organization Name:CHARLES A. AUGUSTUS II, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-245-1611
Mailing Address - Street 1:950 N KROME AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4443
Mailing Address - Country:US
Mailing Address - Phone:305-245-1611
Mailing Address - Fax:305-245-8898
Practice Address - Street 1:950 N KROME AVE STE 403
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4443
Practice Address - Country:US
Practice Address - Phone:305-245-1611
Practice Address - Fax:305-245-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12156OtherBCBS OF FLORIDA
FL054130300Medicaid