Healthcare Provider Details

I. General information

NPI: 1093737678
Provider Name (Legal Business Name): DANIEL R DOBBINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

5901 HARPER DR NE PROVIDER ENROLLMENT
ALBUQUERQUE NM
87109-3587
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1125
  • Fax: 505-841-1737
Mailing address:
  • Phone: 505-823-8528
  • Fax: 505-823-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA-1364-06
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: