1831191972 NPI number — JOHN P. OBERMILLER M.D.

Table of content: CATHERINE A EGAN MS (NPI 1619512530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831191972 NPI number — JOHN P. OBERMILLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBERMILLER
Provider First Name:
JOHN
Provider Middle Name:
P.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831191972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 162622
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78716-2622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-279-2386
Provider Business Mailing Address Fax Number:
512-279-2387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 BEE CAVE ROAD
Provider Second Line Business Practice Location Address:
SUITE C-106
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-279-2386
Provider Business Practice Location Address Fax Number:
512-279-2387
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  G5442 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P2900X , with the licence number: G5442 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1247306-02 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: OB082C502 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1247306-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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