MEDICARE: ROBERT DORSETT R. EP T., CNIM

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1902124951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT DORSETT R. EP T., CNIM

Provider Business Mailing Address
First Line	:	517 PEPPER ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-2449
Country	:	US
Telephone Number	:	626-233-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	13161 MISTY WILLOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5635
Country	:	US
Telephone Number	:	281-970-5900
Fax Number	:	281-970-5913

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

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	01/11/2013

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