Provider Demographics
NPI:1275511214
Name:DORROH, FREDERICK A (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:A
Last Name:DORROH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:731 12TH AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5761
Mailing Address - Country:US
Mailing Address - Phone:580-223-3216
Mailing Address - Fax:580-223-4184
Practice Address - Street 1:731 12TH AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5761
Practice Address - Country:US
Practice Address - Phone:580-223-3216
Practice Address - Fax:580-223-4184
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK25721208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
246728302Medicare PIN
OKE83754Medicare UPIN
246728302Medicare PIN
KYE83754Medicare UPIN