Provider Demographics
NPI:1992777023
Name:DORRIS, MITCHELL F (DPM)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:F
Last Name:DORRIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-432-5052
Mailing Address - Fax:913-432-9990
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-432-5052
Practice Address - Fax:913-432-9990
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000611213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO306842402Medicaid
MO306842402Medicaid
B382899CMedicare ID - Type Unspecified
MO480017004Medicare PIN