MEDICARE: PREMIER OBGYN RGV PLLC

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M2496	OTHER	TX	MD LICENSE

General Provider Information

NPI Number	:	1962919316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER OBGYN RGV PLLC

Provider Business Mailing Address
First Line	:	4217 N MCCOLL RD STE 700
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4466
Country	:	US
Telephone Number	:	956-616-5542
Fax Number	:

Provider Business Practice Location Address
First Line	:	4217 NORTH MCCOLL ROAD
Second Line	:	STE 700
City	:	MCALLEN
State	:	TX
Zip	:	78504
Country	:	US
Telephone Number	:	956-616-5542
Fax Number	:	956-331-2450

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTIAAN A WEBB
Credential	:	MD
Telephone Number	:	956-616-5542

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	06/16/2018

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