Provider Demographics
NPI:1548234974
Name:DORFMAN, ALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:DORFMAN
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 1:5301 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2298
Mailing Address - Country:US
Mailing Address - Phone:636-939-3362
Mailing Address - Fax:636-939-3687
Practice Address - Street 1:5301 VETERANS MEMORIAL PKWY
Practice Address - Street 2:STE 104
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2298
Practice Address - Country:US
Practice Address - Phone:636-939-3362
Practice Address - Fax:636-939-3687
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208127704Medicaid