=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619961919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. RANDY WOBSER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2005
-----------------------------------------------------
Last Update Date | 10/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 MILES CENTER WAY
-----------------------------------------------------
City | DAMARISCOTTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04543-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-563-4700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 MILES CENTER WAY
-----------------------------------------------------
City | DAMARISCOTTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04543-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-563-4700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 77872
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD28663
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 35-07-7934-W
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------