MEDICARE: JEFFREY STEVEN BOBERG D.P.M.

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	213E00000X	Podiatrist	000570	MO
2	213ES0103X	Foot & Ankle Surgery Podiatrist	000570	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00081678	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5031350001	OTHER	MO	DMERC
4	5031350002	OTHER	IL	DMERC

General Provider Information

NPI Number	:	1437264595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY STEVEN BOBERG D.P.M.

Provider Business Mailing Address
First Line	:	9323 PHOENIX VILLAGE PKWY
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-4281
Country	:	US
Telephone Number	:	636-561-0871
Fax Number	:	636-561-5032

Provider Business Practice Location Address
First Line	:	9323 PHOENIX VILLAGE PKWY
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-4281
Country	:	US
Telephone Number	:	636-561-0871
Fax Number	:	636-561-5032

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/10/2021

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Directions to “ JEFFREY STEVEN BOBERG D.P.M.” Practice Location

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