Provider Demographics
NPI:1588641351
Name:DOBLER, NICKOLAS C (PA)
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:C
Last Name:DOBLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19444 HILLSDALE DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9203
Mailing Address - Country:US
Mailing Address - Phone:209-536-5056
Mailing Address - Fax:209-536-3522
Practice Address - Street 1:690 GUZZI LN
Practice Address - Street 2:SUITE B
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5289
Practice Address - Country:US
Practice Address - Phone:209-536-5065
Practice Address - Fax:209-536-3522
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS74028Medicare ID - Type Unspecified