Provider Demographics
NPI:1053452797
Name:DOBBINS, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:DOBBINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:40 TEMPLE ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2715
Mailing Address - Country:US
Mailing Address - Phone:203-777-0304
Mailing Address - Fax:203-401-4687
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-777-0304
Practice Address - Fax:203-401-4687
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT016918207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001169184Medicaid
CTD88759Medicare UPIN
100000253Medicare ID - Type Unspecified