Provider Demographics
NPI:1083649909
Name:DOBBS, GLENN LEE (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:LEE
Last Name:DOBBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 S. EMERSON AVENUE
Mailing Address - Street 2:#400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8633
Mailing Address - Country:US
Mailing Address - Phone:317-865-3600
Mailing Address - Fax:317-865-3850
Practice Address - Street 1:1205 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1789
Practice Address - Country:US
Practice Address - Phone:317-584-3454
Practice Address - Fax:317-584-3435
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001767A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000576533OtherANTHEM PROVIDER #
IN200105500Medicaid
F54011Medicare UPIN
IN200105500Medicaid
IN677690HHHMedicare PIN