Provider Demographics
NPI:1033181839
Name:DOREY, JASON H (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:H
Last Name:DOREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 NORMANDIE DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-269-6337
Mailing Address - Fax:334-834-0657
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:108
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-288-4624
Practice Address - Fax:334-280-3628
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000163702085N0700X, 2085R0202X
FLME904752085N0700X, 2085R0202X
GA0382212085N0700X, 2085R0202X
AL163702085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100324Medicaid
AL106973Medicaid
AL108183Medicaid
AL106971Medicaid
AL108061Medicaid
AL108183Medicaid
AL108061Medicaid
AL106973Medicaid
000035351Medicare PIN
000058867Medicare PIN
AL106971Medicaid
000023739Medicare PIN