Healthcare Provider Details

I. General information

NPI: 1548574247
Provider Name (Legal Business Name): CAPITAL OBGYN ASSOCIATES OF TEXAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 RENFERT WAY SUITE 325
AUSTIN TX
78758-5354
US

IV. Provider business mailing address

12201 RENFERT WAY SUITE 325
AUSTIN TX
78758-5354
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-2536
  • Fax: 512-284-8063
Mailing address:
  • Phone: 512-836-2536
  • Fax: 512-284-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL1141
License Number StateTX

VIII. Authorized Official

Name: DR. JENNIFER LYNN MUSHTALER
Title or Position: OWNER
Credential: M.D.
Phone: 512-836-2536