Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 35125653 | OH |
NPI | 1790927788 |
---|---|
Provider Name | Dr. Edward John Oberle JR. |
First Address | Columbus, OH 43205-2654 |
Second Address | Columbus, OH 43205-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 22/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0119328 | (05) | OH |