Provider Demographics
NPI:1346226057
Name:LOBE, ANDREW K (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
Last Name:LOBE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG B 203
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-674-3847
Mailing Address - Fax:
Practice Address - Street 1:151 S SUNRISE WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0118
Practice Address - Country:US
Practice Address - Phone:760-969-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1060527363A00000X
CAPA20941363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70OtherDEANCARE PROV #
WI391023846OtherCOMMERCIAL INS PROV #
WI1009390OtherPHYS PLUS PROV #
WIP00160692OtherRAILROAD MEDICARE PROV #
WI41990000Medicaid
WIQ21350Medicare UPIN
WI005200130Medicare ID - Type UnspecifiedPART B MEDICARE PROV #