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General NPI Number Information
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NPI Number | 1962447268
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Entity Type | Organization
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Legal Business Name | J LUCAS KOBERDA, MD, PHD, NEUROLOGY, LLC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 4838 KERRY FOREST PKWY
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City | TALLAHASSEE
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State | FL
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Zip | 32309-2272
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Country | US
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Telephone | 850-877-2802
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Fax | 850-222-1383
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Provider Business Mailing Address
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Address Line | 4838 KERRY FOREST PKWY
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City | TALLAHASSEE
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State | FL
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Zip | 32309-2272
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Country | US
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Telephone | 850-877-2802
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Fax | 850-222-1383
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JAROSLAW LUCAS KOBERDA
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Credential |
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Telephone | 850-877-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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