Provider Demographics
NPI:1760646046
Name:WILSON DUMORNAY M D P A
Entity Type:Organization
Organization Name:WILSON DUMORNAY M D P A
Other - Org Name:BROWARD ENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMORNAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-368-3348
Mailing Address - Street 1:4101 S HOSPITAL DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2857
Mailing Address - Country:US
Mailing Address - Phone:954-368-3348
Mailing Address - Fax:954-900-4720
Practice Address - Street 1:4101 S HOSPITAL DR
Practice Address - Street 2:SUITE 14
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2857
Practice Address - Country:US
Practice Address - Phone:954-368-3348
Practice Address - Fax:954-900-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96799207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty