Provider Demographics
NPI:1578333241
Name:DORRIS, DAZMIN
Entity Type:Individual
Prefix:
First Name:DAZMIN
Middle Name:
Last Name:DORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SEVILLE POINT CT
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1066
Mailing Address - Country:US
Mailing Address - Phone:248-759-3016
Mailing Address - Fax:
Practice Address - Street 1:313 SEVILLE POINT CT
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1066
Practice Address - Country:US
Practice Address - Phone:248-759-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2011842207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services