Provider Demographics
NPI:1033244827
Name:DORSOGNA, DESI E (MD)
Entity Type:Individual
Prefix:
First Name:DESI
Middle Name:E
Last Name:DORSOGNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:ELIZABETH
Other - Last Name:DORSOGNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:31225 MEADOW CREEK TRAIL
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4208
Mailing Address - Country:US
Mailing Address - Phone:830-755-8642
Mailing Address - Fax:
Practice Address - Street 1:506 E SAN ANTONIO
Practice Address - Street 2:DETAR HOSPITAL
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77902
Practice Address - Country:US
Practice Address - Phone:361-788-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9343207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E14252Medicare UPIN