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General NPI Number Information
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NPI Number | 1083769939
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Entity Type | Individual
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Provider Name | REBECCA GRUNBAUM BOBO MD
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 1050 SE MONTEREY RD SUITE 104
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-283-2020
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Fax | 772-220-9582
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Provider Business Mailing Address
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Address Line | 1050 SE MONTEREY RD SUITE 104
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-283-2020
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Fax | 772-219-7924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME97719
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License Number State | FL
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