Provider Demographics
NPI:1184648750
Name:DORMISH, JONATHON (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:DORMISH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 E MISSISSIPPI AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6141
Mailing Address - Country:US
Mailing Address - Phone:303-364-3222
Mailing Address - Fax:303-364-2772
Practice Address - Street 1:13701 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6141
Practice Address - Country:US
Practice Address - Phone:303-364-3222
Practice Address - Fax:303-364-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO571213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU75409Medicare UPIN