Healthcare Provider Details

I. General information

NPI: 1700874724
Provider Name (Legal Business Name): DANIEL IVAN BOBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 SHERIDAN ST
HOLLYWOOD FL
33021-3535
US

IV. Provider business mailing address

4440 SHERIDAN ST
HOLLYWOOD FL
33021-3535
US

V. Phone/Fax

Practice location:
  • Phone: 203-232-3189
  • Fax: 954-272-7848
Mailing address:
  • Phone: 203-232-3189
  • Fax: 954-272-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberOS9036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: