Provider Demographics
NPI:1003925033
Name:MOREY, DAWN ELAINE (DO)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ELAINE
Last Name:MOREY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610669
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48061-0669
Mailing Address - Country:US
Mailing Address - Phone:810-985-1884
Mailing Address - Fax:810-966-3025
Practice Address - Street 1:2609 ELECTRIC AVE
Practice Address - Street 2:STE B
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-985-1148
Practice Address - Fax:810-985-1149
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011284208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4844446Medicaid
MI4844446Medicaid
MI4844446Medicaid