Provider Demographics
NPI:1902843030
Name:ELEJE, AUGUSTINE O (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:O
Last Name:ELEJE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N OREGON ST
Mailing Address - Street 2:SUITE 780
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3584
Mailing Address - Country:US
Mailing Address - Phone:915-533-8225
Mailing Address - Fax:866-823-8302
Practice Address - Street 1:1700 N OREGON ST
Practice Address - Street 2:SUITE 780
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3584
Practice Address - Country:US
Practice Address - Phone:915-533-8225
Practice Address - Fax:866-823-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1567207R00000X, 207RA0000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL1567OtherPHYSICIAN LICENSE
TXL1567OtherPHYSICIAN LICENSE