Individual
MR. JEFFERSON KENNETH OBERLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5000 HENNESSY BLVD, OLOL ER, BATON ROUGE, LA 70808-4375
(225) 765-8070
Mailing address
5010 MANCUSO LN, APT # 921, BATON ROUGE, LA 70809-3594
(225) 773-3669
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200070RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1036234
—
LA
Enumeration date
10/18/2007
Last updated
05/15/2008
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