Provider Demographics
NPI:1851307672
Name:BOBBA, MADHURI (MD)
Entity Type:Individual
Prefix:MRS
First Name:MADHURI
Middle Name:
Last Name:BOBBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CARSON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2700
Mailing Address - Country:US
Mailing Address - Phone:719-383-5925
Mailing Address - Fax:719-383-5928
Practice Address - Street 1:1200 CARSON AVE STE 103
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2700
Practice Address - Country:US
Practice Address - Phone:719-383-5925
Practice Address - Fax:719-383-5928
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR44733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03171027Medicaid
COBO678330OtherBLUE CROSS
COP00370636OtherRAILROAD MEDICARE
COI68988Medicare UPIN
CO03171027Medicaid