Provider Demographics
NPI:1073502209
Name:DORTON, DAVID W (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:DORTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6639
Mailing Address - Country:US
Mailing Address - Phone:727-848-3761
Mailing Address - Fax:727-849-0391
Practice Address - Street 1:8220 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6639
Practice Address - Country:US
Practice Address - Phone:727-848-3761
Practice Address - Fax:727-849-0931
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL056384207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250883400Medicaid
FL250883400Medicaid
FL57190Medicare ID - Type Unspecified