Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 46480 | AZ |
N | 2080A0000X | Adolescent Medicine | 46480 | AZ |
NPI | 1255548277 |
---|---|
Provider Name | Michael David Dobbs |
First Address | Phoenix, AZ 85016-8034 |
Second Address | Phoenix, AZ 85008-4948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 23/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
708651 | (05) | AZ |