Doctor Name: | DR. PHILLIP KELLEY BOBO |
NPI Number: | 1184652596 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 00006261 |
Business Practice Address: | 32 15th St Tuscaloosa, AL - 354013661 |
Business Phone Number: | 2053452326 |
Business Fax Number: | 2053450708 |
Mailing Address: | 32 15th St, TUSCALOOSA |
State: | AL |
Postal Code: | 354013661 |
Phone Number: | 2053452326 |
Fax Number: | 2053450708 |
NPI Enumeration Date: | 06/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 00006261 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |