Provider Demographics
NPI:1184651903
Name:ZOBER, JERRY M (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:M
Last Name:ZOBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29425 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4637
Mailing Address - Country:US
Mailing Address - Phone:216-292-0610
Mailing Address - Fax:216-292-0627
Practice Address - Street 1:29425 CHAGRIN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4639
Practice Address - Country:US
Practice Address - Phone:216-292-0610
Practice Address - Fax:216-292-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350388932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A77328Medicare UPIN