Provider Demographics
NPI:1366408940
Name:DOBSON, MARC DAVID (P A)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:DAVID
Last Name:DOBSON
Suffix:
Gender:M
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47110 WASHINGTON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2186
Mailing Address - Country:US
Mailing Address - Phone:760-564-9205
Mailing Address - Fax:760-771-6243
Practice Address - Street 1:47110 WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2186
Practice Address - Country:US
Practice Address - Phone:760-564-9205
Practice Address - Fax:760-771-6243
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1053227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant