Provider Demographics
NPI:1225774375
Name:DORAGE, ANDREW
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:DORAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2893 ECHO AVE
Mailing Address - Street 2:
Mailing Address - City:CALLENDER
Mailing Address - State:IA
Mailing Address - Zip Code:50523-7527
Mailing Address - Country:US
Mailing Address - Phone:151-535-1740
Mailing Address - Fax:
Practice Address - Street 1:1 TRITON CIR
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5729
Practice Address - Country:US
Practice Address - Phone:515-351-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1143612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer