Provider Demographics
NPI:1164408761
Name:GOBAR, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:GOBAR
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 1:5503 S CONGRESS AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6625
Mailing Address - Country:US
Mailing Address - Phone:561-964-7511
Mailing Address - Fax:561-964-7544
Practice Address - Street 1:5503 S CONGRESS AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6625
Practice Address - Country:US
Practice Address - Phone:561-964-7511
Practice Address - Fax:561-964-7544
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN476562084P0800X
FLME1241992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry