Provider Demographics
NPI:1992871883
Name:DORSCH, STEPHEN ERVIN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ERVIN
Last Name:DORSCH
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 1:1638 W 24 HWY
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050
Mailing Address - Country:US
Mailing Address - Phone:816-627-2000
Mailing Address - Fax:816-448-2956
Practice Address - Street 1:1638 W 24 HWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050
Practice Address - Country:US
Practice Address - Phone:816-627-2000
Practice Address - Fax:816-448-2956
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00081623Medicare ID - Type Unspecified
E08141Medicare UPIN