Provider Demographics
NPI:1164506754
Name:BOBBITT, J. DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:DANIEL
Last Name:BOBBITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:645 AMALIA ST, NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2434
Practice Address - Country:US
Practice Address - Phone:704-295-3255
Practice Address - Fax:704-295-3279
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21536174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30077322OtherSELECT HEALTH OF SC
NCP00853306OtherRAILROAD MEDICARE
NC17595OtherWELLPATH
SCQ21536Medicaid
SC771029OtherWELLCARE
NC16403OtherBCBSNC
NC89-16403Medicaid
SC000000307926OtherUNISON HEALTH PLAN OF SC
NC16403OtherBCBSNC
NCC87224Medicare UPIN
NC17595OtherWELLPATH