Provider Demographics
NPI:1699974840
Name:FREDERICK ALAN DORROH MD PC
Entity type:Organization
Organization Name:FREDERICK ALAN DORROH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORROH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-223-3216
Mailing Address - Street 1:PO BOX 269031
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9031
Mailing Address - Country:US
Mailing Address - Phone:580-223-3216
Mailing Address - Fax:580-223-4184
Practice Address - Street 1:2002 12TH AVE NW
Practice Address - Street 2:STE E
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1227
Practice Address - Country:US
Practice Address - Phone:580-223-3216
Practice Address - Fax:580-223-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25721208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE83754Medicare UPIN
600522404Medicare PIN
246728302Medicare PIN