Mark Alan Dobbertien, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

OS 6627 Issued in FL

Practice address

655 W 8TH St
Ufjp Surgery Department
Jacksonville, FL 32209-6511

Phone

(904) 383-1015

Fax

(904) 244-6252

NPI assigned

Feb 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment NPD
• Cajina Anesthesia, PA

  • Anesthesiology Physician
  • Lake City, FL
  • NPI 1538198692
  NPD (past)
• Lake City Medical Center Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Lake City, FL
  • NPI 1407803257
  NPD (past)
• Lake Shore Hma, LLC

  dba Shands Lake Shore Regional Medical Center

  • General Acute Care Hospital
  • Lake City, FL
  • NPI 1386743045
  NPD (past)
• North Florida Emergency Physicians

  • Emergency Medicine Physician
  • Lake City, FL
  • NPI 1538251186
  NPD (past)
• Shands at Lake Shore Inc

  dba Lake Shore Orthopedic Specialists

  • Clinic/Center
  • Lake City, FL
  • NPI 1497854186
  NPD (past)
• Shands Teaching Hospital and Clinics Inc

  • Pharmacy
  • Gainesville, FL
  • NPI 1497645915
  NPD (past)

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1265407043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "address_2": "UFJP PROVIDER ENROLLMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "address_2": "UFJP SURGERY DEPARTMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-383-1015",
            "fax_number": "904-244-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOBBERTIEN",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS 6627",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "OS 6627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "930071111",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3738060-00",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00744004A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2748282-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• VI DO
• Binh Q Doan, MD
• Khoa Doan, PHARMD
• Kim N. Doan, DMD
• Tad C Doan, DO
• Robert Newton Dobbins III, RPH
• Gloria Myriam Dobies, ARNP
• Ashley Doble
• Dorothy Erin Dobleo, OD
• Marcela Ioana Dobren, MD

• Surgery Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.