=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568486264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OBSTETRIX MEDICAL GROUP OF TEXAS BILLING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 E PRESIDENT GEORGE BUSH HWY SUITE 250
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75082-3542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-437-5099
-----------------------------------------------------
Fax | 972-764-1661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 CONCORD TER
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33323-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-384-0175
-----------------------------------------------------
Fax | 954-851-1948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT SECRETARY
-----------------------------------------------------
Name | DR. MICHAEL D DWYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-384-0175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VM0101X
-----------------------------------------------------
Taxonomy Name | Maternal & Fetal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------