MEDICARE: MARY M DOBSON MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	023067	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457335531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY M DOBSON MD LLC

Provider Business Mailing Address
First Line	:	15709 PROFESSIONAL PLZ
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1452
Country	:	US
Telephone Number	:	985-542-9333
Fax Number	:	985-542-4988

Provider Business Practice Location Address
First Line	:	15709 PROFESSIONAL PLZ
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1452
Country	:	US
Telephone Number	:	985-542-9333
Fax Number	:	985-542-4988

Authorized Official
Title or Position	:	SOLE OWNER/PHYSICIAN DERMATOLOGIST
Name	:	DR. MARY MARGARET DOBSON
Credential	:	MD
Telephone Number	:	985-542-9333

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	10/24/2007

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