Provider Demographics
NPI:1245444918
Name:BOBRA, DEEPALI AJITKUMAR (MD)
Entity type:Individual
Prefix:MRS
First Name:DEEPALI
Middle Name:AJITKUMAR
Last Name:BOBRA
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 1:1218 MILLENNIUM PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3895
Mailing Address - Country:US
Mailing Address - Phone:813-684-5255
Mailing Address - Fax:813-654-7457
Practice Address - Street 1:1218 MILLENNIUM PARKWAY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3895
Practice Address - Country:US
Practice Address - Phone:813-684-5255
Practice Address - Fax:813-654-7457
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020386900001Medicaid
PAGU039851OtherMEDICARE GROUP
PAGU039851OtherPA MEDICARE GROUP
NY02927237Medicaid
FL003821600Medicaid
PA118180N86Medicare PIN
NY02927237Medicaid