Provider Demographics
NPI:1417992454
Name:DOBSON, HOWARD DREXEL III (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:DREXEL
Last Name:DOBSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11406
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:321-637-2975
Mailing Address - Fax:321-433-1935
Practice Address - Street 1:1133 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2836
Practice Address - Country:US
Practice Address - Phone:321-637-2975
Practice Address - Fax:321-433-1935
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95065208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276572100Medicaid
FL276572100Medicaid
FLU8818YMedicare PIN