Basic Information
| Provider Information | |||||||||
| NPI: | 1730333543 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9336 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784699336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616941603 | ||||||||
| FaxNumber: | 3616946544 | ||||||||
| Practice Location | |||||||||
| Address1: | 7121 S PADRE ISLAND DR STE 118 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784124946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619801244 | ||||||||
| FaxNumber: | 3619801248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2008 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | OBERMUELLER | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3616945081 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 171695302 | 05 | TX | MEDICAID |