Provider Demographics
NPI:1366519886
Name:DORMAN, ROY LOIL JR (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:LOIL
Last Name:DORMAN
Suffix:JR
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 4505
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4505
Mailing Address - Country:US
Mailing Address - Phone:818-597-3800
Mailing Address - Fax:818-879-8272
Practice Address - Street 1:1111 WEST LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2804
Practice Address - Country:US
Practice Address - Phone:714-999-6080
Practice Address - Fax:714-999-3924
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG872182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHL162429OtherDEPT OF HEALTH SERVICES
BD4594304OtherUS DEPT OF JUSTICE DEA
BD4594304OtherUS DEPT OF JUSTICE DEA
WG87218AMedicare ID - Type Unspecified