Healthcare Provider Details

I. General information

NPI: 1942538459
Provider Name (Legal Business Name): MICHAEL ALAN DORRITY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2952 GARDENS WAY
MEMPHIS TN
38111-2647
US

IV. Provider business mailing address

2952 GARDENS WAY
MEMPHIS TN
38111-2647
US

V. Phone/Fax

Practice location:
  • Phone: 901-327-6543
  • Fax:
Mailing address:
  • Phone: 901-327-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number15224
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number11491
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: