1538599279 NPI number — MRS. DORIAN DOSS MS, RDN, LD, CPT

Table of content: MRS. DORIAN DOSS MS, RDN, LD, CPT (NPI 1538599279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538599279 NPI number — MRS. DORIAN DOSS MS, RDN, LD, CPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOSS
Provider First Name:
DORIAN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, LD, CPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
DORIAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RDN, LD, CPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538599279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 JOST VILLA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63034-2270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-452-3273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 JOST VILLA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63034-2270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-452-3273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2013

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: 133V00000X , with the licence number:  2005038119 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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