Provider Demographics
NPI:1750693529
Name:OUBRE, PHILIP B (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:B
Last Name:OUBRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 BEE CAVES RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5059
Mailing Address - Country:US
Mailing Address - Phone:512-829-1104
Mailing Address - Fax:512-852-6737
Practice Address - Street 1:6836 BEE CAVES RD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5059
Practice Address - Country:US
Practice Address - Phone:512-829-1104
Practice Address - Fax:512-852-6737
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC329219Medicaid
SCSC10662353Medicare PIN
SC329219Medicaid