MEDICARE: DR. LAURENCE I DORMAN DPM

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	213E00000X	Podiatrist	PO1226	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730153016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENCE I DORMAN DPM

Provider Business Mailing Address
First Line	:	8200 NW 27 ST
Second Line	:	STE 108
City	:	DORAL
State	:	FL
Zip	:	33122-1906
Country	:	US
Telephone Number	:	786-662-3893
Fax Number	:	786-660-3899

Provider Business Practice Location Address
First Line	:	9570 SW 107TH AVE
Second Line	:	SUITE 103
City	:	MIAMI
State	:	FL
Zip	:	33176-2788
Country	:	US
Telephone Number	:	305-271-1564
Fax Number	:	305-271-5079

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/22/2014

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