Provider Demographics
NPI:1437177094
Name:BOBADILLA, EVER SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:EVER
Middle Name:SAMUEL
Last Name:BOBADILLA
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 1:3682 FOXFIRE PL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8951
Mailing Address - Country:US
Mailing Address - Phone:706-855-8643
Mailing Address - Fax:
Practice Address - Street 1:915 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4115
Practice Address - Country:US
Practice Address - Phone:706-738-4925
Practice Address - Fax:706-738-7224
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048979207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00881471AMedicaid
GAH24292Medicare UPIN
GA05BDHGZMedicare ID - Type Unspecified