Provider Demographics
NPI:1033178330
Name:BOBO, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:BOBO
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 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:10650 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8538
Practice Address - Country:US
Practice Address - Phone:704-355-2736
Practice Address - Fax:704-355-1865
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002002042085R0001X
SC231042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1302WOtherBLUE CROSS
NC891302WMedicaid
SCN00209Medicaid
2210243OtherUNITED HEALTHCARE
B8156OtherMEDCOST
800593OtherPARTNERS
0256593001OtherCIGNA
2210243OtherUNITED HEALTHCARE
NC1302WOtherBLUE CROSS
800593OtherPARTNERS
SC920007054Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SCN00209Medicaid
NC891302WMedicaid
NC2299459BMedicare ID - Type UnspecifiedUNIVERSITY RAD ONC CTR