Healthcare Provider Details

I. General information

NPI: 1477069854
Provider Name (Legal Business Name): JEFFREY ROBERT DORE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 ASHEVILLE HWY
BREVARD NC
28712
US

IV. Provider business mailing address

212 THOMPSON ST STE A
HENDERSONVILLE NC
28792-2895
US

V. Phone/Fax

Practice location:
  • Phone: 248-760-3720
  • Fax:
Mailing address:
  • Phone: 828-697-3232
  • Fax: 828-698-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-007803
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: