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General NPI Number Information
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NPI Number | 1336246602
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Entity Type | Organization
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Legal Business Name | PETER BROBERG, MD AND ASSOCIATES, PA
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 4207 JAMES CASEY ST STE 305
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City | AUSTIN
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State | TX
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Zip | 78745-1193
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Country | US
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Telephone | 512-447-6096
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 JAMES CASEY ST STE 305
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City | AUSTIN
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State | TX
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Zip | 78745-1193
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Country | US
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Telephone | 512-447-6096
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | ALYSON BISHOP
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Credential |
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Telephone | 512-447-6096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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