Provider Demographics
NPI:1548215908
Name:OB/GYN OF NORTH TEXAS LLP
Entity Type:Organization
Organization Name:OB/GYN OF NORTH TEXAS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-481-5863
Mailing Address - Street 1:1600 WEST COLLEGE AVE
Mailing Address - Street 2:STE 540
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3589
Mailing Address - Country:US
Mailing Address - Phone:817-481-5863
Mailing Address - Fax:817-329-8561
Practice Address - Street 1:1600 W COLLEGE
Practice Address - Street 2:#540
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-481-5863
Practice Address - Fax:817-329-8561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OB/GYN OF NORTH TEXAS, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066AZMedicare ID - Type Unspecified