Provider Demographics
NPI:1841258571
Name:BOBE, RICHARD RODERICK (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RODERICK
Last Name:BOBE
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 1:9363 LAKE SERENA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-6509
Mailing Address - Country:US
Mailing Address - Phone:561-477-5765
Mailing Address - Fax:
Practice Address - Street 1:15340 JOG RD
Practice Address - Street 2:STE 202
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2170
Practice Address - Country:US
Practice Address - Phone:561-330-4177
Practice Address - Fax:561-330-4179
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD22894OtherBC/BS
AZD34107Medicare UPIN
AZMD22894Medicare ID - Type Unspecified