Provider Demographics
NPI:1972548279
Name:KOBERDA, JAROSLAW LUCAS (MD, PHD, NEUROLOGY)
Entity Type:Individual
Prefix:DR
First Name:JAROSLAW
Middle Name:LUCAS
Last Name:KOBERDA
Suffix:
Gender:M
Credentials:MD, PHD, NEUROLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 KERRY FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2272
Mailing Address - Country:US
Mailing Address - Phone:850-877-2802
Mailing Address - Fax:850-222-1383
Practice Address - Street 1:4838 KERRY FOREST PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2272
Practice Address - Country:US
Practice Address - Phone:850-877-2802
Practice Address - Fax:850-222-1383
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME889462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04795803OtherECFMG
BK8550382OtherDEA
FLU8078ZMedicare PIN