Provider Demographics
NPI:1922751270
Name:DOBBS, CARSON CHANDLER
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:CHANDLER
Last Name:DOBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6429
Mailing Address - Country:US
Mailing Address - Phone:256-738-0400
Mailing Address - Fax:
Practice Address - Street 1:1835 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3037
Practice Address - Country:US
Practice Address - Phone:970-565-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist