Provider Demographics
NPI:1386689743
Name:IZMIRLIAN, DOROTHY (DO)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:IZMIRLIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2549
Mailing Address - Country:US
Mailing Address - Phone:941-953-5125
Mailing Address - Fax:941-957-4482
Practice Address - Street 1:4055 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2549
Practice Address - Country:US
Practice Address - Phone:941-953-5125
Practice Address - Fax:941-957-4482
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 7040207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251336600Medicaid
FL57348OtherBLUE CROSS BLUE SHIELD
FL251336600Medicaid
FL57348OtherBLUE CROSS BLUE SHIELD