Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME79078 | FL |
NPI | 1003192246 |
---|---|
Provider Name | Dr. Sandra Dorsey |
First Address | Brandon, FL 33511 |
Second Address | Brandon, FL 33511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D45239 | (02) |