Provider Demographics
NPI:1366495970
Name:DORSETT, JEFFREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:DORSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1126
Mailing Address - Country:US
Mailing Address - Phone:913-755-3044
Mailing Address - Fax:913-755-2149
Practice Address - Street 1:100 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1126
Practice Address - Country:US
Practice Address - Phone:913-755-3044
Practice Address - Fax:913-755-2149
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100145220AMedicaid
E11802Medicare UPIN
KS033D00011Medicare PIN