Provider Demographics
NPI:1417144858
Name:DORSETT, ALLEN RAY (DO)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:RAY
Last Name:DORSETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 PASADENA FWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-1400
Mailing Address - Country:US
Mailing Address - Phone:713-475-8686
Mailing Address - Fax:713-475-8688
Practice Address - Street 1:923 PASADENA FWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-1400
Practice Address - Country:US
Practice Address - Phone:713-475-8686
Practice Address - Fax:713-475-8688
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6266207LP2900X, 207RA0401X, 208100000X, 208VP0000X, 208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CL695OtherBCBS IND. NUMBER
TX2163123-01Medicaid
TX2163123-01Medicaid