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General NPI Number Information
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NPI Number | 1124235304
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Entity Type | Individual
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Provider Name | JILL M DORSEY MD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 807 CHILDRENS WAY NEMOURS CHILDRENS CLINIC, JACKSONVILLE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8426
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Country | US
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Telephone | 904-697-3694
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Fax | 904-697-3927
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Provider Business Mailing Address
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Address Line | P.O. BOX 5720 PROVIDER ENROLLMENT DEPARTMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32247-5720
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Country | US
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Telephone | 302-651-6201
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Fax | 407-650-7578
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 57009706
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | ME102416
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License Number State | FL
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