Organization
FIRST COAST PODIATRIC SURGERY AND WOUND CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORG ALEXANDER BOBER DPM (OWNER/PODIATRIST)
(904) 422-1566
Entity
Organization
Contact information
Practice address
1409 KINGSLEY AVE, SUITE 9-G, ORANGE PARK, FL 32073-4537
(904) 637-0037
Mailing address
PO BOX 1653, ORANGE PARK, FL 32067-1653
(904) 637-0037
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO 3294
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018B
BCBS
FL
05
—
002932200
—
FL
Enumeration date
07/29/2010
Last updated
03/01/2011
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