Provider Demographics
NPI:1881693133
Name:BOBEK, MIROSLAV PATRICK (MD)
Entity type:Individual
Prefix:
First Name:MIROSLAV
Middle Name:PATRICK
Last Name:BOBEK
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 1:2900 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8475
Mailing Address - Country:US
Mailing Address - Phone:541-779-1672
Mailing Address - Fax:541-779-0986
Practice Address - Street 1:2900 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8475
Practice Address - Country:US
Practice Address - Phone:541-779-1672
Practice Address - Fax:541-779-0986
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066110207T00000X
ORMD23617207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286530Medicaid
H62547Medicare UPIN
R162591Medicare PIN