Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | N6266 | TX |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | N6266 | TX |
Y | 2081P2900X | Pain Medicine | N6266 | TX |
NPI | 1417144858 |
---|---|
Provider Name | Allen Ray Dorsett |
First Address | Pasadena, TX 77506-1400 |
Second Address | Pasadena, TX 77506-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2007 |
Last Update Date | 10/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2163123-01 | (05) | TX |
8CL695 | BCBS IND. NUMBER (01) | TX |