Provider Demographics
NPI:1194705038
Name:DORSEY, JOHN HENRY JR (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:DORSEY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PARKWAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-761-3889
Mailing Address - Fax:207-761-1874
Practice Address - Street 1:195 FORE RIVER PARKWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-761-3889
Practice Address - Fax:207-761-1874
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD144213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME441480540OtherRAIL ROAD MEDICARE
ME428010099Medicaid
MET31654Medicare UPIN
ME600644Medicare PIN
ME441480540OtherRAIL ROAD MEDICARE
ME60064401Medicare PIN