Provider Demographics
NPI:1073685822
Name:TOM W DORRELL JR MD PA
Entity Type:Organization
Organization Name:TOM W DORRELL JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:W
Authorized Official - Last Name:DORRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:361-949-1900
Mailing Address - Street 1:14433 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5938
Mailing Address - Country:US
Mailing Address - Phone:361-949-1900
Mailing Address - Fax:361-949-2005
Practice Address - Street 1:14433 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5938
Practice Address - Country:US
Practice Address - Phone:361-949-1900
Practice Address - Fax:361-949-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX79LZOtherBLUECROSS BLUESHIELD
TX00615XMedicare PIN