Basic Information
Provider Information
NPI: 1801562186
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOBSON
FirstName: REID
MiddleName: CAMERON
NamePrefix:  
NameSuffix:  
Credential:  
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OtherCredential:  
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Mailing Information
Address1: 7505 N LOOP 1604 E STE 101
Address2:  
City: LIVE OAK
State: TX
PostalCode: 782332604
CountryCode: US
TelephoneNumber: 2105904000
FaxNumber: 2105904585
Practice Location
Address1: 1973 NW LOOP 410 STE 102
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782132250
CountryCode: US
TelephoneNumber: 2108123827
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/18/2021
LastUpdateDate: 08/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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