1376795302 NPI number — STEWART M. DOBBINS II MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376795302 NPI number — STEWART M. DOBBINS II MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEWART M. DOBBINS II MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUNTERS CREEK PEDIATRICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376795302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12554 S JOHN YOUNG PKWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32837-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-856-9966
Provider Business Mailing Address Fax Number:
407-816-2214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12554 S JOHN YOUNG PKWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-856-9966
Provider Business Practice Location Address Fax Number:
407-816-2214
Provider Enumeration Date:
10/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DOBBINS
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
407-856-9966

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME69272 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2633426000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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