Healthcare Provider Details

I. General information

NPI: 1932295730
Provider Name (Legal Business Name): RICHARD IRA DORIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO BLVD SE MEDICAL SERVICE 111
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

2526 ELFEGO RD NW
ALBUQUERQUE NM
87107-3011
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-2803
Mailing address:
  • Phone: 505-265-1711
  • Fax: 505-256-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number88-155
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: