Provider Demographics
NPI:1417951997
Name:DORSETT, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:DORSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:ANDREW
Other - Last Name:DORSETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1135 WHISKEYTOWN CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0227
Mailing Address - Country:US
Mailing Address - Phone:530-245-0742
Mailing Address - Fax:530-245-0539
Practice Address - Street 1:1135 WHISKEYTOWN CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0227
Practice Address - Country:US
Practice Address - Phone:530-245-0742
Practice Address - Fax:530-245-0539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67624225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G676241Medicaid
CA00G676241Medicaid
CAF25359Medicare UPIN