Provider Demographics
NPI:1063760502
Name:JEROME R OBED D.O.,P.A.
Entity type:Organization
Organization Name:JEROME R OBED D.O.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:R
Authorized Official - Last Name:OBED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-990-6591
Mailing Address - Street 1:500 SE 15TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1952
Mailing Address - Country:US
Mailing Address - Phone:954-990-6591
Mailing Address - Fax:
Practice Address - Street 1:500 SE 15TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1952
Practice Address - Country:US
Practice Address - Phone:954-990-6591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty