Provider Demographics
NPI:1992036750
Name:PER A DOVRE MD INC
Entity Type:Organization
Organization Name:PER A DOVRE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:PER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOVRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-872-2229
Mailing Address - Street 1:6283 CLARK RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-872-2229
Mailing Address - Fax:530-872-3308
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:SUITE 8
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-872-2229
Practice Address - Fax:530-872-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19317207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid
CAPENDINGMedicare PIN