Provider Demographics
NPI:1922299379
Name:DORNER PLASTIC SURGERY
Entity Type:Organization
Organization Name:DORNER PLASTIC SURGERY
Other - Org Name:BRIAN K DORNER MD INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DORNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-336-9000
Mailing Address - Street 1:4930 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1215
Mailing Address - Country:US
Mailing Address - Phone:614-336-9000
Mailing Address - Fax:614-336-9001
Practice Address - Street 1:4930 BRADENTON AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1215
Practice Address - Country:US
Practice Address - Phone:614-336-9000
Practice Address - Fax:614-336-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1473654208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBR9346931Medicare PIN