Healthcare Provider Details

I. General information

NPI: 1992036750
Provider Name (Legal Business Name): PER A DOVRE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6283 CLARK RD SUITE 8
PARADISE CA
95969-4100
US

IV. Provider business mailing address

6283 CLARK RD SUITE 8
PARADISE CA
95969-4100
US

V. Phone/Fax

Practice location:
  • Phone: 530-872-2229
  • Fax: 530-872-3308
Mailing address:
  • Phone: 530-872-2229
  • Fax: 530-872-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG19317
License Number StateCA

VIII. Authorized Official

Name: PER A DOVRE
Title or Position: PRESIDENT/MD
Credential: MD
Phone: 530-872-2229