Provider Demographics
NPI:1346229762
Name:DVORAK, DOUGLAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:W
Last Name:DVORAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:STE 101
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-359-1646
Mailing Address - Fax:563-344-6703
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:STE 101
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-359-1646
Practice Address - Fax:563-344-6703
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA28701207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG03118Medicare UPIN