Maribeth Cruz Bobadilla, M.D.

Individual provider Active NPI Family Medicine Physician · Willis, TX

NPI 1083907893 · NPPES record last updated Jul 5, 2016

Key facts

NPI
1083907893
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
P8763 (TX)
Practice address
201 Lincoln RDG
Willis, TX 77378-1420
Phone
(936) 539-4004
NPI assigned
May 26, 2011
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P8763TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lone Star Community Health Center, Inc. Family Medicine Past
since Jan 25, 2016
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X P8763 TX Yes

Addresses

Primary practice location

201 Lincoln RDG
Willis, TX 77378-1420

Mailing address

605 S Conroe Medical Dr
Conroe, TX 77304-4722
Phone (936) 539-4004

Other providers in Willis, TX

All providers in Willis, TX · Family Medicine Physician in Texas

Sources for this page

Verify at the official NPI Registry.