Provider Demographics
NPI:1326088584
Name:DORR, CLYDE H (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:H
Last Name:DORR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-7800
Mailing Address - Fax:850-416-4937
Practice Address - Street 1:5045 CARPENTER CREEK DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2521
Practice Address - Country:US
Practice Address - Phone:850-416-2400
Practice Address - Fax:850-416-2467
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92339207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255346500Medicaid
FLC15343Medicare UPIN
FL44224Medicare ID - Type Unspecified