Healthcare Provider Details

I. General information

NPI: 1083769939
Provider Name (Legal Business Name): REBECCA GRUNBAUM BOBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANTOINETTE GRUNBAUM M.D.

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD SUITE 104
STUART FL
34994-4512
US

IV. Provider business mailing address

1050 SE MONTEREY RD SUITE 104
STUART FL
34994-4512
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-2020
  • Fax: 772-220-9582
Mailing address:
  • Phone: 772-283-2020
  • Fax: 772-219-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME97719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: