Healthcare Provider Details

I. General information

NPI: 1003860370
Provider Name (Legal Business Name): RICHARD C DORE' RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 WEBER RD
FARMINGTON MO
63640-3325
US

IV. Provider business mailing address

908 GREEN BRIAR DR
FARMINGTON MO
63640-7160
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-4581
  • Fax:
Mailing address:
  • Phone: 573-756-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111287
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: