Provider Demographics
NPI:1518958776
Name:GOBO, DEAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:J
Last Name:GOBO
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 1:400 PINELLAS ST STE 325
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3320
Mailing Address - Country:US
Mailing Address - Phone:727-298-6121
Mailing Address - Fax:727-298-6151
Practice Address - Street 1:400 PINELLAS ST
Practice Address - Street 2:SUITE 325
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3312
Practice Address - Country:US
Practice Address - Phone:727-298-6121
Practice Address - Fax:727-533-5903
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70807207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000705800Medicaid
FLP01024476OtherMEDICARE RAILROAD PROVIDER NUMBER
G27741Medicare UPIN
FL31963XMedicare PIN
FL31963UMedicare PIN
FL31963VMedicare PIN
FL000705800Medicaid