MEDICARE: JEFFREY A KOBY PAC

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	363A00000X	Physician Assistant	834	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	550691297	OTHER	WV	SELECT NET
2	550691297	OTHER	WV	TRICARE
3	550691297	OTHER	WV	4 MOST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	001712511	OTHER	WV	BLUE CROSS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871563528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY A KOBY PAC

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:
Fax Number	:	904-450-6401

Provider Business Practice Location Address
First Line	:	4203 BELFORT RD STE 345
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1469
Country	:	US
Telephone Number	:	904-450-6461
Fax Number	:	904-450-6469

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/23/2018

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Directions to “ JEFFREY A KOBY PAC” Practice Location

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