Provider Demographics
NPI:1760473664
Name:DOBRY, MARY MIGNONETTE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MIGNONETTE
Last Name:DOBRY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4130 LA JOLLA VILLAGE DR
Mailing Address - Street 2:#207
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-784-0590
Mailing Address - Fax:858-784-0594
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR
Practice Address - Street 2:#207
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-784-0590
Practice Address - Fax:858-784-0594
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2008-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG067293207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67293Medicare PIN
CAF29605Medicare UPIN