Provider Demographics
NPI:1174510168
Name:OBERST, MARY L (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:OBERST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 11TH CT STE 102
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5012
Mailing Address - Country:US
Mailing Address - Phone:772-778-8687
Mailing Address - Fax:772-778-3680
Practice Address - Street 1:3450 11TH CT STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-778-8687
Practice Address - Fax:772-778-3680
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP288207RC0000X
KY51164207RC0000X
TXK4972207RC0000X
TN42530207RC0000X
OK22894207RC0000X
HIMD-15388207RC0000X
VA0101269315207RC0000X
FLME125665207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100064670AMedicaid
OK100064670AMedicaid
OKH43725Medicare UPIN