Healthcare Provider Details

I. General information

NPI: 1306805650
Provider Name (Legal Business Name): ROBERT M DORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W COLLEGE AVE
SHELBY NC
28152-8111
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-818-9200
  • Fax:
Mailing address:
  • Phone: 704-874-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: