1982694659 NPI number — PAUL J DORSHER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982694659 NPI number — PAUL J DORSHER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DORSHER

Provider First Name:

PAUL

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1982694659

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/25/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1900 CENTRACARE CIR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAINT CLOUD

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

56303-5000

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

320-240-2205

Provider Business Mailing Address Fax Number:

320-229-5174

Provider First Line Business Practice Location Address:

1900 CENTRACARE CIR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAINT CLOUD

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

56303-5000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

320-240-2205

Provider Business Practice Location Address Fax Number:

320-229-5174

Provider Enumeration Date:

10/25/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RG0100X , with the licence number:  23508 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 100000453 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2900273 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: 600909 . This is a "ARAZ GROUP/AMERICA'S PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 6D062DO . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "ONE HEALTH PLAN/GREAT WES" identifier . This identifiers is of the category "OTHER".
• Identifier: 110897 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 986007 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
• Identifier: 505R1DO(PL) . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: HP25426 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 800124 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "MMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 110104489 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 795068300 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".