Provider Demographics
NPI:1124068325
Name:RAHMANIAN, BOBAK REZA (DO)
Entity type:Individual
Prefix:DR
First Name:BOBAK
Middle Name:REZA
Last Name:RAHMANIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9279
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-9279
Mailing Address - Country:US
Mailing Address - Phone:239-440-6456
Mailing Address - Fax:239-236-0337
Practice Address - Street 1:13691 METRO PKWY STE 400
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4349
Practice Address - Country:US
Practice Address - Phone:239-440-6456
Practice Address - Fax:239-236-0337
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS911207P00000X
FLOS11406207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA015OtherTRICARE
HI53784704Medicaid
HI53784705Medicaid
HI53784705Medicaid
HIH103590Medicare PIN
HIH30367Medicare UPIN