MEDICARE: HOWARD LESLIE DORNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	G57108	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	G57108	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00151437	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	00G571080	OTHER	BLUE SHIELD OF CA
2	053304CA53237	OTHER	TRAILBLAZER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	00G571080 M46	OTHER	CALOPTIMA

General Provider Information

NPI Number	:	1376543140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD LESLIE DORNE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6898
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-6898
Country	:	US
Telephone Number	:	714-571-5000
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	1140 W LA VETA AVE
Second Line	:	STE. 850
City	:	ORANGE
State	:	CA
Zip	:	92868-4225
Country	:	US
Telephone Number	:	714-560-4450
Fax Number	:	714-560-4455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/18/2008

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Directions to “ HOWARD LESLIE DORNE M.D.” Practice Location

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