Provider Demographics
NPI:1396922217
Name:JEFFREY L BOBER, DPM PA
Entity type:Organization
Organization Name:JEFFREY L BOBER, DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BOBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-761-9606
Mailing Address - Street 1:7845 OAKWOOD RD STE 308
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4266
Mailing Address - Country:US
Mailing Address - Phone:410-761-9606
Mailing Address - Fax:443-628-0239
Practice Address - Street 1:7845 OAKWOOD RD STE 308
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4266
Practice Address - Country:US
Practice Address - Phone:410-761-9606
Practice Address - Fax:443-628-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1060213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0752730001Medicare NSC