Provider Demographics
NPI:1760647325
Name:ST DAVIDS OB HOSPITALIST PLLC
Entity Type:Organization
Organization Name:ST DAVIDS OB HOSPITALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-708-9700
Mailing Address - Street 1:98 SAN JACINTO BLVD
Mailing Address - Street 2:STE 1800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 SAN JACINTO BLVD
Practice Address - Street 2:STE 1800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4082
Practice Address - Country:US
Practice Address - Phone:512-482-4107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0293Medicare PIN