Provider Demographics
NPI:1639108343
Name:DORMAN, CAROLINE D (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:D
Last Name:DORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1160 PATTERSON RD
Mailing Address - Street 2:PO BOX 62
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8275
Mailing Address - Country:US
Mailing Address - Phone:970-298-2800
Mailing Address - Fax:970-298-7522
Practice Address - Street 1:1160 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8275
Practice Address - Country:US
Practice Address - Phone:970-298-2800
Practice Address - Fax:970-298-7522
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO642922OtherBC/BS ANTHEM COLORADO
CO19333331Medicaid
CO080152599OtherRAIL ROAD MEDICARE
COC303199Medicare PIN
COH02645Medicare UPIN
CO62524Medicare ID - Type Unspecified