Provider Demographics
NPI:1013904531
Name:OBERMAN, RONALD (D P M)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:OBERMAN
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1401
Mailing Address - Country:US
Mailing Address - Phone:954-421-9600
Mailing Address - Fax:954-421-8910
Practice Address - Street 1:1891 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1401
Practice Address - Country:US
Practice Address - Phone:954-421-9600
Practice Address - Fax:954-421-8910
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2135213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU32559Medicare UPIN
FL65240XMedicare PIN