Provider Demographics
NPI:1083769939
Name:BOBO, REBECCA GRUNBAUM (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:GRUNBAUM
Last Name:BOBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANTOINETTE
Other - Last Name:GRUNBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-283-2020
Mailing Address - Fax:772-219-7924
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-283-2020
Practice Address - Fax:772-220-9582
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97719207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2075532OtherCIGNA
FL4950OtherEVOLUTIONS
FL05589OtherBLUE CROSS BLUE SHIELD FL
FL0181368OtherGHI
FL9381076OtherAETNA
FLFL53641OtherVISION BENEFITS OF AMERIC
FL25534OtherCOVENTRY HEALTH CARE
FLFL53641OtherVISION BENEFITS OF AMERIC
FL2075532OtherCIGNA
FL05589OtherBLUE CROSS BLUE SHIELD FL
FLAH773YMedicare PIN