Provider Demographics
NPI:1215291075
Name:DOBERSTEIN, TAYLOR B (DO)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:B
Last Name:DOBERSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8003
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-8003
Mailing Address - Country:US
Mailing Address - Phone:920-830-5900
Mailing Address - Fax:920-738-5787
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ STE 240
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2790
Practice Address - Country:US
Practice Address - Phone:920-831-5050
Practice Address - Fax:920-727-4511
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI61412207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology