1487895892 NPI number — DR. ANDREW JONATHAN DORFMAN M.D.

Table of content: DR. TATE N TRUJILLO PHARMD (NPI 1629192901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487895892 NPI number — DR. ANDREW JONATHAN DORFMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORFMAN
Provider First Name:
ANDREW
Provider Middle Name:
JONATHAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORFMAN
Provider Other First Name:
ANDREW
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487895892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97228-8400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-708-7005
Provider Business Mailing Address Fax Number:
541-708-5092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 NW 14TH AVE
Provider Second Line Business Practice Location Address:
NO. 417
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97209-2792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-944-6770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  153293 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: G72918 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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