Provider Demographics
NPI:1225642622
Name:DOR MEDICAL SERVICES
Entity Type:Organization
Organization Name:DOR MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:772-501-1868
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33425-0568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 LANDINGS BLVD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-2027
Practice Address - Country:US
Practice Address - Phone:772-501-1868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service