Provider Demographics
NPI:1154323855
Name:DORWAY, DAVID DIXON (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DIXON
Last Name:DORWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1737
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89125-1737
Mailing Address - Country:US
Mailing Address - Phone:702-671-6809
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:#260
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-870-2099
Practice Address - Fax:702-407-0266
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018189Medicaid
NVCS01857OtherSTATE PHARMACY
NV003102189Medicaid
NV3582OtherMEDICAL LICENSE
NV3582OtherMEDICAL LICENSE
NVDM959ZMedicare PIN
NVCS01857OtherSTATE PHARMACY