MEDICARE: DR. PETER BROBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	F3054	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	180037540	OTHER	TX	PALMETTO RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8088J0	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326040635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER BROBERG M.D.

Provider Business Mailing Address
First Line	:	4207 JAMES CASEY ST
Second Line	:	STE 305
City	:	AUSTIN
State	:	TX
Zip	:	78745-1193
Country	:	US
Telephone Number	:	512-447-6096
Fax Number	:	512-447-2247

Provider Business Practice Location Address
First Line	:	4207 JAMES CASEY ST
Second Line	:	STE 305
City	:	AUSTIN
State	:	TX
Zip	:	78745-1193
Country	:	US
Telephone Number	:	512-447-6096
Fax Number	:	512-447-2247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/30/2012

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Directions to “ DR. PETER BROBERG M.D.” Practice Location

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