MEDICARE: RICHARD A OBERG MD

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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	13728	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220016968	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	3067964	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225005846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A OBERG MD

Provider Business Mailing Address
First Line	:	1804 HIGHWAY 45 BYP
Second Line	:	SUITE 604
City	:	JACKSON
State	:	TN
Zip	:	38305-4436
Country	:	US
Telephone Number	:	731-660-8759
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 W FOREST AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3901
Country	:	US
Telephone Number	:	731-660-8759
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	05/31/2026

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Directions to “ RICHARD A OBERG MD” Practice Location

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