Provider Demographics
NPI:1629079686
Name:DORA, DAVID LEON (DO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEON
Last Name:DORA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:LEON
Other - Last Name:DORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:3443 FARR RD
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-8779
Practice Address - Country:US
Practice Address - Phone:231-672-2900
Practice Address - Fax:231-672-2901
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2590390Medicaid
MI112590390OtherMUSKEGON CARE/ACCESS HEAL
MI101635OtherPREFERRED CHOICE
MI102OtherCOMMUNITY CHOICE
MI18799OtherHEALTH PLAN OF MICHIGAN
MI112590390OtherMUSKEGON CARE/ACCESS HEAL