Provider Demographics
NPI:1831191972
Name:OBERMILLER, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:OBERMILLER
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:PO BOX 162622
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-2622
Mailing Address - Country:US
Mailing Address - Phone:512-279-2386
Mailing Address - Fax:512-279-2387
Practice Address - Street 1:4201 BEE CAVE ROAD
Practice Address - Street 2:SUITE C-106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6493
Practice Address - Country:US
Practice Address - Phone:512-279-2386
Practice Address - Fax:512-279-2387
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5442208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1247306-02OtherCSHCN
TXOB082C502OtherBCBS
TX1247306-02Medicaid
TX82C502Medicare ID - Type Unspecified
TX1247306-02OtherCSHCN
TXOB082C502OtherBCBS