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General NPI Number Information
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NPI Number | 1720108012
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Entity Type | Individual
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Provider Name | JORG A BOBER DPM
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 1409 KINGSLEY AVE SUITE 9-G
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-637-0037
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1653
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City | ORANGE PARK
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State | FL
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Zip | 32067-1653
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Country | US
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Telephone | 904-422-1566
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3942
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | PO3294
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License Number State | FL
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