MEDICARE: JOHN P. OBERMILLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	G5442	TX
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	G5442	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1247306-02	OTHER	TX	CSHCN
2	OB082C502	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831191972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P. OBERMILLER M.D.

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

Provider Business Practice Location Address
First Line	:	4201 BEE CAVE ROAD
Second Line	:	SUITE C-106
City	:	AUSTIN
State	:	TX
Zip	:	78746-6493
Country	:	US
Telephone Number	:	512-279-2386
Fax Number	:	512-279-2387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/21/2008

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Directions to “ JOHN P. OBERMILLER M.D.” Practice Location

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