Provider Demographics
NPI:1801021126
Name:OBERG, THOMAS J J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J J
Last Name:OBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:JONATHAN JACKSON
Other - Last Name:OBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:755 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2105
Mailing Address - Country:US
Mailing Address - Phone:520-349-6140
Mailing Address - Fax:
Practice Address - Street 1:5200 S HIGHLAND DR STE 201
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7003
Practice Address - Country:US
Practice Address - Phone:801-363-3356
Practice Address - Fax:801-533-9613
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7771826-1205207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology