Provider Demographics
NPI:1912944802
Name:HOBSON, DONNIS S (MD)
Entity Type:Individual
Prefix:
First Name:DONNIS
Middle Name:S
Last Name:HOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HAWTHORNE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-419-0211
Mailing Address - Fax:510-419-0140
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-419-0211
Practice Address - Fax:510-419-0140
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG31452208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG314520Medicaid
OOG314522Medicare ID - Type Unspecified
A44779Medicare UPIN