Provider Demographics
NPI:1922056670
Name:OBRASKY, JAMES ERWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERWIN
Last Name:OBRASKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:E
Other - Last Name:OBRASKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13085
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92039-3085
Mailing Address - Country:US
Mailing Address - Phone:858-232-2593
Mailing Address - Fax:
Practice Address - Street 1:2400 E 4TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2026
Practice Address - Country:US
Practice Address - Phone:858-232-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20587207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G205872Medicaid
CA00G205870Medicaid
CA006205871Medicaid
CAG20587Medicare ID - Type Unspecified
CA006205871Medicaid
CAF54252Medicare UPIN