Provider Demographics
NPI:1346245636
Name:DORFAN, HERBERT ISAAC (MD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:ISAAC
Last Name:DORFAN
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 1:6560 FANNIN ST
Mailing Address - Street 2:STE 1616
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2734
Mailing Address - Country:US
Mailing Address - Phone:713-795-0515
Mailing Address - Fax:713-795-0563
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 1616
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2734
Practice Address - Country:US
Practice Address - Phone:713-795-0515
Practice Address - Fax:713-795-0563
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD62502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15339Medicare UPIN
TX00K810Medicare ID - Type Unspecified