Provider Demographics
NPI:1003251489
Name:JOHN H. DORAN,M.D., P.L.LC.
Entity Type:Organization
Organization Name:JOHN H. DORAN,M.D., P.L.LC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:M,D,
Authorized Official - Phone:432-333-3295
Mailing Address - Street 1:700 DOTSY AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4238
Mailing Address - Country:US
Mailing Address - Phone:432-333-3295
Mailing Address - Fax:432-333-8840
Practice Address - Street 1:700 DOTSY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4238
Practice Address - Country:US
Practice Address - Phone:432-333-3295
Practice Address - Fax:432-333-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0890261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD48239Medicare UPIN