Healthcare Provider Details

I. General information

NPI: 1891748844
Provider Name (Legal Business Name): MARY JANE HOBEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WHITTINGTON PKWY SUITE 301
LOUISVILLE KY
40222-4928
US

IV. Provider business mailing address

320 WHITTINGTON PKWY SUITE 301
LOUISVILLE KY
40222-4928
US

V. Phone/Fax

Practice location:
  • Phone: 502-625-5584
  • Fax: 502-426-2264
Mailing address:
  • Phone: 502-625-5584
  • Fax: 502-426-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number26739
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: