Individual
DR. MARK ALAN DOBBERTIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
655 W 8TH ST, UFJP SURGERY DEPARTMENT, JACKSONVILLE, FL 32209-6511
(904) 383-1015
(904) 244-6252
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
OS 6627
FL
208600000X
Surgery Physician
Primary
OS 6627
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00744004A
—
GA
05
—
2748282-00
—
FL
05
—
3738060-00
—
FL
01
—
930071111
RR MEDICARE
FL
Enumeration date
02/23/2006
Last updated
01/11/2011
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