Provider Demographics
NPI:1164584942
Name:DORFMAN, GARY R (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:DORFMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 W SAHARA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2873
Mailing Address - Country:US
Mailing Address - Phone:702-878-2455
Mailing Address - Fax:702-878-4875
Practice Address - Street 1:7135 W SAHARA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2873
Practice Address - Country:US
Practice Address - Phone:702-878-2455
Practice Address - Fax:702-878-4875
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1101213ES0103X
NV12LL01213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164584942Medicaid
NV1164584942Medicaid
NVHG295ZMedicare PIN