Provider Demographics
NPI:1528179108
Name:DORNAN, JOYCE J (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:J
Last Name:DORNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CLINT MOORE RD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2800
Mailing Address - Country:US
Mailing Address - Phone:561-241-6676
Mailing Address - Fax:
Practice Address - Street 1:902 CLINT MOORE RD
Practice Address - Street 2:SUITE 227
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2800
Practice Address - Country:US
Practice Address - Phone:561-241-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226754207Q00000X
FLME 105938207Q00000X
FLME105938207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54866Medicare UPIN
013859U11Medicare ID - Type Unspecified