Provider Demographics
NPI:1003852559
Name:DOORENBOS, PAMELA D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:D
Last Name:DOORENBOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 HOSPITAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4479
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:
Practice Address - Street 1:9825 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4479
Practice Address - Country:US
Practice Address - Phone:763-494-7500
Practice Address - Fax:763-494-7501
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN096522700Medicaid
MNG73764Medicare UPIN