Provider Demographics
NPI:1457335531
Name:MARY M DOBSON MD LLC
Entity Type:Organization
Organization Name:MARY M DOBSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/PHYSICIAN DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-542-9333
Mailing Address - Street 1:15709 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1452
Mailing Address - Country:US
Mailing Address - Phone:985-542-9333
Mailing Address - Fax:985-542-4988
Practice Address - Street 1:15709 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1452
Practice Address - Country:US
Practice Address - Phone:985-542-9333
Practice Address - Fax:985-542-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023067207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1483907Medicaid
LA1483907Medicaid
LAG95313Medicare UPIN