Individual
JEFFREY STEVEN BOBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
9323 PHOENIX VILLAGE PKWY, O FALLON, MO 63368-4281
(636) 561-0871
(636) 561-5032
Mailing address
9323 PHOENIX VILLAGE PKWY, O FALLON, MO 63368-4281
(636) 561-0871
(636) 561-5032
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
000570
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000570
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302436829
—
MO
01
—
5031350001
DMERC
MO
01
—
5031350002
DMERC
IL
01
—
P00081678
RAILROAD MEDICARE
MO
Enumeration date
08/20/2006
Last updated
05/10/2021
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