Provider Demographics
NPI:1730149238
Name:PAMELA S DOLBER DPM PA
Entity type:Organization
Organization Name:PAMELA S DOLBER DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DOLBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-699-0710
Mailing Address - Street 1:3 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-1806
Mailing Address - Country:US
Mailing Address - Phone:863-699-0710
Mailing Address - Fax:863-699-0701
Practice Address - Street 1:3 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-1806
Practice Address - Country:US
Practice Address - Phone:863-699-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2842213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340365300Medicaid
FLU0233AMedicare PIN
FL340365300Medicaid
FL5398640001Medicare NSC