Provider Demographics
NPI:1891898383
Name:DORN, JOSEPH C (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:DORN
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:P.O. BOX 45
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32345-0045
Mailing Address - Country:US
Mailing Address - Phone:850-997-2714
Mailing Address - Fax:850-997-9926
Practice Address - Street 1:193 NURSERY RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344
Practice Address - Country:US
Practice Address - Phone:850-997-2714
Practice Address - Fax:850-997-9926
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D17696Medicare UPIN