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General NPI Number Information
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NPI Number | 1013100544
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Entity Type | Organization
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Legal Business Name | BOBEK ENTERPRISES PC
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 515 15TH ST
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City | ASTORIA
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State | OR
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Zip | 97103-3812
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Country | US
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Telephone | 503-325-5411
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Fax | 503-325-3711
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Provider Business Mailing Address
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Address Line | 515 15TH ST
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City | ASTORIA
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State | OR
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Zip | 97103-3812
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Country | US
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Telephone | 503-325-5411
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Fax | 503-325-3711
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE LOUIS BOBEK
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Credential | D.O.
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Telephone | 503-325-5411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DO16469
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License Number State | OR
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