Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | J2712 | TX |
NPI | 1003043027 |
---|---|
Provider Name | Robert Obrien |
First Address | Austin, TX 78745-1116 |
Second Address | Austin, TX 78745-1116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 17/06/2009 |