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NPI Code Detail

MEDICARE: ROBERT OBENRADER PA

MEDICARE: ROBERT OBENRADER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9103661FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063461135
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT OBENRADER PA
Provider Business Mailing Address
First Line : 7544 JACQUE RD
Second Line :
City : HUDSON
State : FL
Zip : 34667-7162
Country : US
Telephone Number : 727-697-2200
Fax Number : 727-863-8774
Provider Business Practice Location Address
First Line : 7544 JACQUE RD
Second Line :
City : HUDSON
State : FL
Zip : 34667-7162
Country : US
Telephone Number : 727-697-2200
Fax Number : 727-863-8774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 10/07/2008

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Directions to “ ROBERT OBENRADER PA” Practice Location

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