Provider Demographics
NPI:1730333543
Name:DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP
Entity type:Organization
Organization Name:DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERMUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-694-5081
Mailing Address - Street 1:PO BOX 9336
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78469-9336
Mailing Address - Country:US
Mailing Address - Phone:361-694-1603
Mailing Address - Fax:361-694-6544
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 118
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4946
Practice Address - Country:US
Practice Address - Phone:361-980-1244
Practice Address - Fax:361-980-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171695302Medicaid