Provider Demographics
NPI:1992019442
Name:DOBBERTIN, MATTHEW DEAN (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DEAN
Last Name:DOBBERTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:DEAN
Other - Last Name:DOBBERTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-498-6540
Mailing Address - Fax:531-355-0001
Practice Address - Street 1:14092 BOYS TOWN HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010
Practice Address - Country:US
Practice Address - Phone:531-355-1449
Practice Address - Fax:531-355-0001
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63962084P0800X
NE9822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry