Provider Demographics
NPI:1699190504
Name:DORMAN, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:DORMAN
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 1:3327 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-5655
Mailing Address - Country:US
Mailing Address - Phone:414-559-5546
Mailing Address - Fax:866-301-9533
Practice Address - Street 1:3327 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5655
Practice Address - Country:US
Practice Address - Phone:414-559-5546
Practice Address - Fax:866-301-9533
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0691209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine