Healthcare Provider Details

I. General information

NPI: 1568458529
Provider Name (Legal Business Name): JOHN FRANKLIN BOBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENDEN DR
WOOSTER OH
44691-2568
US

IV. Provider business mailing address

1056 BRIGANTINE AVE
UNIONTOWN OH
44685-6241
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-9029
  • Fax: 330-263-7251
Mailing address:
  • Phone: 330-689-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35.052930
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: