Provider Demographics
NPI:1487895892
Name:DORFMAN, ANDREW JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JONATHAN
Last Name:DORFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:J
Other - Last Name:DORFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 28457
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-8400
Mailing Address - Country:US
Mailing Address - Phone:541-708-7005
Mailing Address - Fax:541-708-5092
Practice Address - Street 1:720 NW 14TH AVE
Practice Address - Street 2:NO. 417
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2792
Practice Address - Country:US
Practice Address - Phone:541-944-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR153293207Q00000X
CAG72918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine