Healthcare Provider Details

I. General information

NPI: 1215291075
Provider Name (Legal Business Name): TAYLOR B DOBERSTEIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 THEDA CLARK MEDICAL PLZ STE 240
NEENAH WI
54956-2790
US

IV. Provider business mailing address

PO BOX 8003
APPLETON WI
54912-8003
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-5050
  • Fax: 920-727-4511
Mailing address:
  • Phone: 920-830-5900
  • Fax: 920-738-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number61412
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: