Provider Demographics
NPI:1861486896
Name:DOBSON, JOSEPH ROBERT (DO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:DOBSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S MONROE AVE
Mailing Address - Street 2:#106
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4054
Mailing Address - Country:US
Mailing Address - Phone:920-437-4366
Mailing Address - Fax:920-437-0954
Practice Address - Street 1:424 S MONROE AVE
Practice Address - Street 2:#106
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4054
Practice Address - Country:US
Practice Address - Phone:920-437-4366
Practice Address - Fax:920-437-0954
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26550207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30021900Medicaid
80085001OtherRR MEDICARE
80085001OtherRR MEDICARE
000075900001Medicare ID - Type Unspecified