Provider Demographics
NPI:1720168958
Name:DOBSON, WALTER ALBERT (DO)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:ALBERT
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 1:647 S GREAT SOUTHWEST PARKWAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051
Mailing Address - Country:US
Mailing Address - Phone:972-660-3188
Mailing Address - Fax:972-602-0613
Practice Address - Street 1:647 S GREAT SOUTHWEST PARKWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051
Practice Address - Country:US
Practice Address - Phone:972-660-3188
Practice Address - Fax:972-602-0613
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3512208600000X
OH34002298208600000X
TXF26362086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000FE048Medicaid
TXP000FE048Medicaid
FE04Medicare ID - Type Unspecified