Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | OS014132 | PA |
NPI | 1508064668 |
---|---|
Provider Name | Dr. Raymond Scott Bobb |
First Address | Philadelphia, PA 19131-4714 |
Second Address | Philadelphia, PA 19131-4714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 26/05/2017 |