Healthcare Provider Details

I. General information

NPI: 1033292750
Provider Name (Legal Business Name): MICHAEL W BEBBINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/22/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MUELLER BLVD STE 130
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

4910 MUELLER BLVD STE 130
AUSTIN TX
78723-3079
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0040
  • Fax: 512-879-6834
Mailing address:
  • Phone: 512-324-0040
  • Fax: 512-879-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2016029129
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberP2827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: