Broberg, Peter

Broberg, Peter is an individual health care provider with primary practice located at 4207 James Casey St Ste 305, Austin TX 78745-1193. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Broberg, Peter can be contacted via phone (512) 447-6096.

Contact Information

Primary practice address
4207 James Casey St Ste 305 Austin TX 78745-1193
Phone: (512) 447-6096
Fax: (512) 447-2247
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X F3054 Texas

Profile Details

NPI number 1326040635
LBN Legal business name Broberg, Peter
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Jan 30th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326040635 NPPES
Texas Other 8088J0 BLUE CROSS BLUE SHIELD
Texas MEDICAID 114047703 BLUE CROSS BLUE SHIELD
Texas Other 180037540 BLUE CROSS BLUE SHIELD

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