Provider Demographics
NPI:1578519773
Name:DORSAY, BRADFORD CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:CHARLES
Last Name:DORSAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61726 JOAN CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9348
Mailing Address - Country:US
Mailing Address - Phone:541-382-6390
Mailing Address - Fax:
Practice Address - Street 1:2115 NE WYATT CT
Practice Address - Street 2:SUITE 201
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7678
Practice Address - Country:US
Practice Address - Phone:541-382-9110
Practice Address - Fax:541-389-5459
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORVAD000Medicare UPIN