Healthcare Provider Details

I. General information

NPI: 1972548279
Provider Name (Legal Business Name): JAROSLAW LUCAS KOBERDA M.D., PHD, NEUROLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 KERRY FOREST PKWY
TALLAHASSEE FL
32309-2272
US

IV. Provider business mailing address

4838 KERRY FOREST PKWY
TALLAHASSEE FL
32309-2272
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-2802
  • Fax: 850-222-1383
Mailing address:
  • Phone: 850-877-2802
  • Fax: 850-222-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME88946
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: