Provider Demographics
NPI:1285668210
Name:ARMBRISTER, DORNA EVERTON (MD)
Entity type:Individual
Prefix:
First Name:DORNA
Middle Name:EVERTON
Last Name:ARMBRISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DORNA
Other - Middle Name:EVERTON
Other - Last Name:FLASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:888-403-1071
Mailing Address - Fax:
Practice Address - Street 1:1800 COMMUNITY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-8804
Practice Address - Country:US
Practice Address - Phone:888-403-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018038087207Q00000X
PAMD418379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH79297Medicare UPIN
PA067673Medicare ID - Type Unspecified