Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 227175 | MA |
N | 208600000X | Surgeon | 227175 | MA |
Y | 2086S0102X | Surgical Critical Care | 227175 | MA |
NPI | 1306837190 |
---|---|
Provider Name | Jon D. Dorfman |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 18/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110073533A | (05) | MA |