Provider Demographics
NPI:1063554038
Name:DOBARD, DENNIS P JR (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:DOBARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 W ELFINDALE STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-708-9089
Mailing Address - Fax:417-708-9089
Practice Address - Street 1:1721 W ELFINDALE STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-708-9089
Practice Address - Fax:417-708-9089
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR1055012084P0800X
MO1055012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207699505Medicaid
AR126374001Medicaid
P00472586OtherRR MEDICARE
MO1063554038Medicaid
MO81733OtherAR BLUE SHIELD #
MO1063554038Medicaid
MO207699505Medicaid
MO81733OtherAR BLUE SHIELD #
MOMA1327004Medicare PIN