Healthcare Provider Details

I. General information

NPI: 1588908727
Provider Name (Legal Business Name): EDWARD PATRICK OBOYLE RDMS,RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2012
Last Update Date: 11/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 CASTELLAN LN
ROUND ROCK TX
78665-5689
US

IV. Provider business mailing address

2940 CASTELLAN LN
ROUND ROCK TX
78665-5689
US

V. Phone/Fax

Practice location:
  • Phone: 512-350-6463
  • Fax:
Mailing address:
  • Phone: 512-350-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number47841
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number47841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: