Healthcare Provider Details

I. General information

NPI: 1649257395
Provider Name (Legal Business Name): WILLIAM ROSCOE DORSEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 MIAMISBURG CENTERVILLE RD STE 201
CENTERVILLE OH
45459-3711
US

IV. Provider business mailing address

2591 MIAMISBURG CENTERVILLE RD STE 201
CENTERVILLE OH
45459-3711
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-5252
  • Fax: 937-439-9242
Mailing address:
  • Phone: 937-439-5252
  • Fax: 937-439-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number3897
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number3897
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: