Provider Demographics
NPI:1508973629
Name:DOBNER, SHERRI J (DO)
Entity Type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:J
Last Name:DOBNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 ETZEL AVE # 158
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-1906
Mailing Address - Country:US
Mailing Address - Phone:636-728-9940
Mailing Address - Fax:636-283-6260
Practice Address - Street 1:2345 DOUGHERTY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3313
Practice Address - Country:US
Practice Address - Phone:314-966-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130865207P00000X
MO106339207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1508973629Medicaid
MO152360411Medicare PIN
MOG19683Medicare UPIN
IL214881Medicare Oscar/Certification
MO150050019Medicare PIN
MO120050069Medicare ID - Type Unspecified