Individual
JACK E. DOBKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
106 PARKVIEW DR, LAURENS, SC 29360-2652
(864) 984-0571
(864) 984-3610
Mailing address
DEPT LA 23039, PASADENA, CA 91185-3039
(562) 282-4038
(562) 658-3397
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
20A8076
CA
207RC0000X
Cardiovascular Disease Physician
Primary
51708
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX80760
—
CA
01
—
020A80760
BLUE SHIELD ID #
—
01
—
044862
HEALHT NET ID #
—
05
—
517088
—
SC
01
—
60066531
RAILROAD
—
01
—
60066532
RAILROAD
—
Enumeration date
05/26/2006
Last updated
07/16/2019
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