Provider Demographics
NPI:1689740144
Name:DORLAC, WARREN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:CHARLES
Last Name:DORLAC
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-203-7520
Mailing Address - Fax:970-203-7256
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 2200
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-203-7520
Practice Address - Fax:970-203-7256
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0053091208600000X, 2086S0102X
OH35 0909632086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77758528Medicaid
CO77758528Medicaid