Provider Demographics
NPI:1669742755
Name:ST. DAVID'S ORTHO, NEURO AND REHAB, PLLC
Entity type:Organization
Organization Name:ST. DAVID'S ORTHO, NEURO AND REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARBONELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-708-9700
Mailing Address - Street 1:98 SAN JACINTO BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4082
Mailing Address - Country:US
Mailing Address - Phone:512-708-9700
Mailing Address - Fax:512-410-2942
Practice Address - Street 1:98 SAN JACINTO BLVD
Practice Address - Street 2:SUITE 1800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4082
Practice Address - Country:US
Practice Address - Phone:512-708-9700
Practice Address - Fax:512-410-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty