Healthcare Provider Details

I. General information

NPI: 1629058821
Provider Name (Legal Business Name): JOHN ROBERT DORSCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
DAYTON OH
45433-5529
US

IV. Provider business mailing address

1434 BAREBACK TRL
BEAVERCREEK OH
45434-5618
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-0855
  • Fax:
Mailing address:
  • Phone: 937-912-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2011-00786
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number02002516A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number201100786
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: