Healthcare Provider Details

I. General information

NPI: 1891825022
Provider Name (Legal Business Name): MICHELLE DOROZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S YALE ST BLDG 2 SUITE 150
FLAGSTAFF AZ
86001-7304
US

IV. Provider business mailing address

3260 S MERRYVALE LN
FLAGSTAFF AZ
86001-6567
US

V. Phone/Fax

Practice location:
  • Phone: 928-527-4325
  • Fax: 928-527-4327
Mailing address:
  • Phone: 928-527-4325
  • Fax: 928-527-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4045
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR-50509
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: