Provider Demographics
NPI:1447555313
Name:JOHN W OBBINK, JR. M.D., P.A.
Entity type:Organization
Organization Name:JOHN W OBBINK, JR. M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:OBBINK
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:817-346-9111
Mailing Address - Street 1:6401 HARRIS PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-6101
Mailing Address - Country:US
Mailing Address - Phone:817-346-9111
Mailing Address - Fax:817-346-9714
Practice Address - Street 1:6401 HARRIS PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6101
Practice Address - Country:US
Practice Address - Phone:817-346-9111
Practice Address - Fax:817-346-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0149261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE99562Medicare UPIN
TX00360MMedicare PIN