Provider Demographics
NPI:1538282736
Name:DOBYNS, WILLIAM BRIAN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRIAN
Last Name:DOBYNS
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:PO BOX 50010
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5003
Mailing Address - Country:US
Mailing Address - Phone:206-987-8450
Mailing Address - Fax:206-987-8484
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 0077
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-0525
Practice Address - Fax:773-834-0505
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099156208000000X
WAMD60152986207SG0201X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099156Medicaid
ILL68170Medicare ID - Type Unspecified
IL036099156Medicaid