MEDICARE: MR. DENNIS RAY DOERKSEN PA-C

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	363A00000X	Physician Assistant	PA03549	TX

General Provider Information

NPI Number	:	1427021500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS RAY DOERKSEN PA-C

Provider Business Mailing Address
First Line	:	1733 PLEASONTON RD
Second Line	:	BUILDING 801
City	:	FORT BLISS
State	:	TX
Zip	:	79916-6816
Country	:	US
Telephone Number	:	915-569-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	4316 LOMA DE BRISAS DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3701
Country	:	US
Telephone Number	:	915-822-2065
Fax Number	:

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/08/2007

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