Provider Demographics
NPI:1639296924
Name:DOVER, ERIC ALAN (ERIC DOVER, MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:DOVER
Suffix:
Gender:M
Credentials:ERIC DOVER, MD
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:ALAN
Other - Last Name:DOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ERIC DOVER, MD
Mailing Address - Street 1:11705 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2141
Mailing Address - Country:US
Mailing Address - Phone:503-408-1610
Mailing Address - Fax:
Practice Address - Street 1:11705 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2141
Practice Address - Country:US
Practice Address - Phone:503-408-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine