MEDICARE: JEFFREY G LOBAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0203X	Pediatric Critical Care Medicine Physician	32163	IA
2	2080P0203X	Pediatric Critical Care Medicine Physician	37874	AZ
3	2080P0214X	Pediatric Pulmonology Physician	036-128419	IL
4	208000000X	Pediatrics Physician	89271	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41639	OTHER	IA	WELLMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043206162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY G LOBAS MD

Provider Business Mailing Address
First Line	:	313 TALL OAK
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92603-0673
Country	:	US
Telephone Number	:	480-789-1819
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 TALL OAK
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92603-0673
Country	:	US
Telephone Number	:	480-789-1819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	06/29/2016

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