Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 107778 | MO |
NPI | 1053329912 |
---|---|
Provider Name | Victoria Joan Dorr |
First Address | Lubbock, TX 79407-2520 |
Second Address | Lubbock, TX 79412-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 21/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207991829 | (05) | MO |
3609901 | UHC (01) | |
8200 | BCBS (01) | |
G04907 | (02) |