Provider Demographics
NPI:1528250149
Name:OBERHOFF, SCOTT WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WAYNE
Last Name:OBERHOFF
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 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4002
Mailing Address - Fax:512-901-3902
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4002
Practice Address - Fax:512-901-3902
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5915207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5915OtherTEXAS STATE BOARD OF MEDICAL EXAMINERS
TX341460901Medicaid
TX341460901Medicaid