Provider Demographics
NPI:1982881215
Name:DORFMAN, GAIL CHIRA
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:CHIRA
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2140
Mailing Address - Country:US
Mailing Address - Phone:651-690-4100
Mailing Address - Fax:651-690-4100
Practice Address - Street 1:1747 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2140
Practice Address - Country:US
Practice Address - Phone:651-690-4100
Practice Address - Fax:651-690-4100
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3374030000OtherMN HEALTH CARE PROGRAMS