Healthcare Provider Details

I. General information

NPI: 1275097271
Provider Name (Legal Business Name): ROBERT H DORSETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 CHERRY ST
BERKELEY CA
94705-2309
US

IV. Provider business mailing address

2817 CHERRY ST
BERKELEY CA
94705-2309
US

V. Phone/Fax

Practice location:
  • Phone: 510-646-7059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG36009
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: