Provider Demographics
NPI:1790786382
Name:DOBKIN, MARVIN (DPM)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:DOBKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5309
Mailing Address - Country:US
Mailing Address - Phone:520-881-3338
Mailing Address - Fax:520-881-0780
Practice Address - Street 1:2825 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5309
Practice Address - Country:US
Practice Address - Phone:520-881-3338
Practice Address - Fax:520-881-0780
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0117213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1Z8514OtherHEALTH NET
AZ860298630OtherHUMANA
AZAZ0065730OtherBLUE CROSS BLUE SHIELD
AZ701202Medicaid
AZ4094652OtherAETNA
AZ480012486OtherRAILROAD MEDICARE
AZ860298630OtherUNITED HEALTHCARE
AZ0630650001Medicare NSC
1Z8514OtherHEALTH NET
AZ480012486OtherRAILROAD MEDICARE