Healthcare Provider Details

I. General information

NPI: 1639285315
Provider Name (Legal Business Name): BOB KWESI TORGBEDE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TWO DATRAN CENTER SUITE 1202 9130 S DADELAND BOULEVARD
MIAMI FL
33156
US

IV. Provider business mailing address

5331 SW 184TH WAY
MIRAMAR FL
33029-6296
US

V. Phone/Fax

Practice location:
  • Phone: 786-888-8820
  • Fax: 786-888-8820
Mailing address:
  • Phone: 786-888-8820
  • Fax: 305-595-3088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: