Healthcare Provider Details

I. General information

NPI: 1578397097
Provider Name (Legal Business Name): DOR MORE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-7000
  • Fax:
Mailing address:
  • Phone: 727-298-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: