MEDICARE: DR. DOUGLAS B DORNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	19028	IA

General Provider Information

NPI Number	:	1134113491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS B DORNER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4907
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50306-4907
Country	:	US
Telephone Number	:	515-241-5785
Fax Number	:	515-241-4415

Provider Business Practice Location Address
First Line	:	1440 PLEASANT ST
Second Line	:	STE 100
City	:	DES MOINES
State	:	IA
Zip	:	50314-1708
Country	:	US
Telephone Number	:	515-241-5700
Fax Number	:	515-241-8691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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