Lisa Ann Dynan-Dobbertien, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS6382 Issued in FL

Practice address

3229 Bear Run Blvd
Clay County Health Dept -BLDG a
Orange Park, FL 32065

Phone

(904) 213-3202

Fax

(904) 272-4353

NPI assigned

Feb 21, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296777600000",
    "number": "1255306627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 578",
            "address_2": "CLAY COUNTY HEALTH DEPARTMENT",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320430578",
            "telephone_number": "904-529-2800",
            "fax_number": "904-529-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3229 BEAR RUN BLVD",
            "address_2": "CLAY COUNTY HEALTH DEPT -BLDG A",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32065",
            "telephone_number": "904-213-3202",
            "fax_number": "904-272-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYNAN-DOBBERTIEN",
        "first_name": "LISA",
        "middle_name": "ANN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2011-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS6382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377329900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.