Healthcare Provider Details

I. General information

NPI: 1710337381
Provider Name (Legal Business Name): IAN DOBBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TONGASS AVE
KETCHIKAN AK
99901-5746
US

IV. Provider business mailing address

400 HOBART ST C/O HEATHER BYERS
CADILLAC MI
49601-2331
US

V. Phone/Fax

Practice location:
  • Phone: 907-228-5171
  • Fax: 907-228-8335
Mailing address:
  • Phone: 231-876-7807
  • Fax: 231-876-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD220649
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number146579
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301109401
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD220649
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number146579
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: