Provider Demographics
NPI:1932140886
Name:JONATHON J DORMISH DPM LLC
Entity Type:Organization
Organization Name:JONATHON J DORMISH DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:J
Authorized Official - Last Name:DORMISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-364-3222
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:13701 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6141
Practice Address - Country:US
Practice Address - Phone:303-364-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41629353Medicaid
CODE9870OtherRAILROAD MEDICARE
CO41629353Medicaid