Provider Demographics
NPI:1841253036
Name:DOBBS, HERMAN ALLEN III (MD)
Entity type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:ALLEN
Last Name:DOBBS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:387 N 2ND AVE
Mailing Address - Street 2:UNIT 1B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1540
Mailing Address - Country:US
Mailing Address - Phone:602-616-3118
Mailing Address - Fax:
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-768-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34742207Q00000X
NM96-44207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ590134OtherMEDICAID
F39250Medicare UPIN