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General NPI Number Information
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NPI Number | 1609024470
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Entity Type | Individual
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Provider Name | JONATHAN SCOTT DORN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 6065 N TROPICAL TRL
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-7212
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Country | US
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Telephone | 321-863-4986
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Fax | 321-453-3786
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Provider Business Mailing Address
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Address Line | 6065 N TROPICAL TRL
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-7212
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Country | US
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Telephone | 321-863-4986
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Fax | 321-453-3786
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME37620
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | ME37620
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License Number State | FL
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