Healthcare Provider Details

I. General information

NPI: 1386689743
Provider Name (Legal Business Name): DOROTHY IZMIRLIAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 BEE RIDGE RD
SARASOTA FL
34233-2549
US

IV. Provider business mailing address

4055 BEE RIDGE RD
SARASOTA FL
34233-2549
US

V. Phone/Fax

Practice location:
  • Phone: 941-953-5125
  • Fax: 941-957-4482
Mailing address:
  • Phone: 941-953-5125
  • Fax: 941-957-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberOS 7040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: