Provider Demographics
NPI:1588612006
Name:BOBB, MICHAEL D JR (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BOBB
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43777-1284
Mailing Address - Country:US
Mailing Address - Phone:740-697-7373
Mailing Address - Fax:740-697-7683
Practice Address - Street 1:1010 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-1284
Practice Address - Country:US
Practice Address - Phone:919-690-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00926207Q00000X
OH34008666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417932294OtherGROUP NPI
OH0989499Medicaid
CA0426OtherGROUP MEDICARE PTAN
OH2620597Medicaid
OH0989499Medicaid
OH4174612Medicare PIN
9270902Medicare PIN