Provider Demographics
NPI:1457413775
Name:FAHNBULLEH, AUGUSTUS T SR (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:T
Last Name:FAHNBULLEH
Suffix:SR
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:PO BOX 941478
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-8478
Mailing Address - Country:US
Mailing Address - Phone:713-979-0251
Mailing Address - Fax:713-979-0366
Practice Address - Street 1:7333 NORTH FWY STE 311
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1320
Practice Address - Country:US
Practice Address - Phone:713-979-0251
Practice Address - Fax:713-979-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169653601Medicaid
TXG94580Medicare UPIN
8B8726Medicare PIN