Basic Information
| Provider Information | |||||||||
| NPI: | 1205879590 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | IKE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2102 TREASURE HILLS BLVD | ||||||||
| Address2: | #3.144.05 | ||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562961437 | ||||||||
| FaxNumber: | 9562961326 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 E TORONTO AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785031209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566876155 | ||||||||
| FaxNumber: | 9566820597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F3724 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | F3724 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100267706 | 05 | TX | MEDICAID | 1002677-05 | 05 | TX | MEDICAID | 100267707 | 01 | TX | MEDICAID-CSHCN | OTHER |