Provider Demographics
NPI:1396273066
Name:AUGUSTYNIAK, JOBETH (DO)
Entity type:Individual
Prefix:DR
First Name:JOBETH
Middle Name:
Last Name:AUGUSTYNIAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N RUSK AVE
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-3047
Mailing Address - Country:US
Mailing Address - Phone:903-647-4511
Mailing Address - Fax:903-209-2962
Practice Address - Street 1:214 N RUSK AVE
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3047
Practice Address - Country:US
Practice Address - Phone:903-647-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10059384207Q00000X
TXR8860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine