Provider Demographics
NPI:1912959412
Name:DOHRMANN, MARY L (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:DOHRMANN
Suffix:
Gender:F
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 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:500 N KEENE ST STE 406
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-884-3278
Practice Address - Fax:573-884-1351
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7611207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205003304Medicaid
MO2087020301OtherKANSAS MEDICAID
MO126987OtherBLUE CHOICE/BLUE SHIELD
MO2502038OtherUNITED HEALTHCARE
MO433221OtherHEALTHLINK
MOP00415550Medicare PIN