Provider Demographics
NPI:1194835470
Name:JAMES C. BOBROW, INC.
Entity Type:Organization
Organization Name:JAMES C. BOBROW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOBROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-721-1140
Mailing Address - Street 1:121 HUNTER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2000
Mailing Address - Country:US
Mailing Address - Phone:314-721-1140
Mailing Address - Fax:314-721-1863
Practice Address - Street 1:121 HUNTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2000
Practice Address - Country:US
Practice Address - Phone:314-721-1140
Practice Address - Fax:314-721-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0703660001Medicare NSC
MO000009024Medicare PIN