Organization
EAST SIDE FAMILY PRACTICE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ROBERT DOBSON D.O. (PRESIDENT)
(920) 437-4366
Entity
Organization
Contact information
Practice address
424 S MONROE AVE STE 106, GREEN BAY, WI 54301-4054
(920) 437-4366
(920) 437-0954
Mailing address
424 S MONROE AVE STE 106, GREEN BAY, WI 54301-4054
(920) 437-4366
(920) 437-0954
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26550
WI
208D00000X
General Practice Physician
26550
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30021900
—
WI
01
—
80085001
RR MEDICARE PROV #
—
Enumeration date
02/22/2007
Last updated
10/25/2010
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