Organization
JEFFREY S BOBERG DPM LLC
Active
Other names
Ankle & Foot Surgeons of the Midwest
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY S BOBERG DPM (PRESIDENT/PHYSICIAN)
(314) 739-7100
Entity
Organization
Contact information
Practice address
12255 DE PAUL DR, STE 100, BRIDGETON, MO 63044-2510
(314) 739-7100
(314) 739-3199
Mailing address
12255 DE PAUL DR, STE 100, BRIDGETON, MO 63044-2510
(314) 739-7100
(314) 739-3199
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000570
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
016004233
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
016005131
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
016005217
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
2003013610
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
2005026457
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500008107
—
MO
01
—
DA9953
RAILROAD MEDICARE
MO
01
—
DC4793
RAILROAD MEDICARE
IL
Enumeration date
08/31/2006
Last updated
11/23/2009
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