MEDICARE: MR. JOHN HENRY DORAN MSW

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	1041C0700X	Clinical Social Worker	L292170	MI

General Provider Information

NPI Number	:	1407800071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN HENRY DORAN MSW

Provider Business Mailing Address
First Line	:	401 CINDY LN
Second Line	:
City	:	LORENA
State	:	TX
Zip	:	76655-3469
Country	:	US
Telephone Number	:	254-857-3394
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 MEMORIAL DR
Second Line	:	SWS 122W
City	:	WACO
State	:	TX
Zip	:	76711-1329
Country	:	US
Telephone Number	:	254-297-3560
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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