Healthcare Provider Details

I. General information

NPI: 1982694659
Provider Name (Legal Business Name): PAUL J DORSHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 11/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-2205
  • Fax: 320-229-5174
Mailing address:
  • Phone: 320-240-2205
  • Fax: 320-229-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number23508
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: