| Organization Name: | EAST SIDE FAMILY PRACTICE SC |
| NPI Number: | 1861527863 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH ROBERT DOBSON (PRESIDENT) |
| Mailing Address: | 424 S Monroe Ave Ste 106 Green Bay |
| State: | WI US |
| Postal Code: | 543014054 |
| Phone Number: | 9204374366 |
| Fax Number: | 9204370954 |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 10/25/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 26550 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |