MEDICARE: PAUL J DORSHER MD

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	207RG0100X	Gastroenterology Physician	23508	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100000453	OTHER		MEDICARE
13	110104489	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	2900273	OTHER	MEDICA HEALTH PLANS
3	600909	OTHER	ARAZ GROUP/AMERICA'S PPO
4	6D062DO	OTHER	BLUE CROSS BLUE SHIELD
5	COMP	OTHER	ONE HEALTH PLAN/GREAT WES
6	110897	OTHER	U CARE
7	986007	OTHER	PREFERRED ONE
8	505R1DO(PL)	OTHER	BLUE CROSS BLUE SHIELD
9	HP25426	OTHER	HEALTH PARTNERS
10	800124	OTHER	FIRST HEALTH PLAN
11	COMP	OTHER	CHAMPUS
12	COMP	OTHER	MMSI
14	795068300	OTHER	MEDICAL ASSISTANCE

General Provider Information

NPI Number	:	1982694659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J DORSHER MD

Provider Business Mailing Address
First Line	:	1900 CENTRACARE CIR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-5000
Country	:	US
Telephone Number	:	320-240-2205
Fax Number	:	320-229-5174

Provider Business Practice Location Address
First Line	:	1900 CENTRACARE CIR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-5000
Country	:	US
Telephone Number	:	320-240-2205
Fax Number	:	320-229-5174

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	11/25/2011

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