Provider Demographics
NPI:1972574317
Name:AMY VAN DORFY M D P A
Entity Type:Organization
Organization Name:AMY VAN DORFY M D P A
Other - Org Name:LIVE OAK MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER /PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAN DORFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-693-2005
Mailing Address - Street 1:608 GATEWAY CENTRAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-6354
Mailing Address - Country:US
Mailing Address - Phone:830-693-2005
Mailing Address - Fax:830-798-2006
Practice Address - Street 1:608 GATEWAY CENTRAL
Practice Address - Street 2:SUITE 100
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-6354
Practice Address - Country:US
Practice Address - Phone:830-693-2005
Practice Address - Fax:830-798-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00737ZMedicare PIN