Provider Demographics
NPI:1265753719
Name:SOBBING, JACKSON (DO)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:SOBBING
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:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1522
Mailing Address - Country:US
Mailing Address - Phone:316-685-7234
Mailing Address - Fax:316-685-0317
Practice Address - Street 1:3232 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3003
Practice Address - Country:US
Practice Address - Phone:316-685-7234
Practice Address - Fax:316-685-0317
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-35881207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110296019Medicare PIN