Healthcare Provider Details

I. General information

NPI: 1427291236
Provider Name (Legal Business Name): DUSTIN ALAN PAGORIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 ILLINOIS AVE
STEVENS POINT WI
54481-3112
US

IV. Provider business mailing address

824 ILLINOIS AVE
STEVENS POINT WI
54481-3112
US

V. Phone/Fax

Practice location:
  • Phone: 715-342-7500
  • Fax:
Mailing address:
  • Phone: 715-342-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number55685
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: