Individual
BOBBY SE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-3582
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(019) 845-6156
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35104
MS
207RH0003X
Hematology & Oncology Physician
35104
MS
390200000X
Student in an Organized Health Care Education/Training Program
0116036429
VA
Other
Enumeration date
06/13/2022
Last updated
08/24/2025
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