Provider Demographics
NPI:1245288893
Name:BOBADILLA, JOSEPH L (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:BOBADILLA
Suffix:
Gender:M
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:UNIVERSITY OF KENTUCKY VASCULAR SURGERY
Mailing Address - Street 2:800 ROSE STREET, C213
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-6346
Mailing Address - Fax:859-323-6840
Practice Address - Street 1:UNIVERSITY OF KENTUCKY VASCULAR SURGERY
Practice Address - Street 2:800 ROSE STREET, C213
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-6346
Practice Address - Fax:859-323-6840
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48319208600000X, 390200000X
KY45509208600000X
KYTP5752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100206840Medicaid
KY7100206840Medicaid