Provider Demographics
NPI:1215900857
Name:DOBSON, CARL LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:LEROY
Last Name:DOBSON
Suffix:
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 1:3401 W. GORE BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6332
Mailing Address - Country:US
Mailing Address - Phone:580-355-8620
Mailing Address - Fax:580-250-5827
Practice Address - Street 1:3401 W. GORE BLVD.
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6332
Practice Address - Country:US
Practice Address - Phone:580-355-8620
Practice Address - Fax:580-250-5827
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG95832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00003380OtherMEDICARE RAILROAD
TXDO08J0201OtherBCBS
TX123838OtherCHIPS
TX136917511Medicaid
TX136917511Medicaid
TX123838OtherCHIPS