1790786382 NPI number — MARVIN DOBKIN DPM

Table of content: MARVIN DOBKIN DPM (NPI 1790786382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790786382 NPI number — MARVIN DOBKIN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBKIN
Provider First Name:
MARVIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1790786382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2825 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85716-5309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-881-3338
Provider Business Mailing Address Fax Number:
520-881-0780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 E BROADWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85716-5309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-881-3338
Provider Business Practice Location Address Fax Number:
520-881-0780
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  0117 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1Z8514 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 860298630 . This is a "HUMANA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0065730 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 701202 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4094652 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 480012486 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 860298630 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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