Provider Demographics
NPI:1255392247
Name:DORNER, BRIAN K (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:DORNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6425 POST RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-1225
Mailing Address - Country:US
Mailing Address - Phone:614-336-9000
Mailing Address - Fax:614-336-9001
Practice Address - Street 1:6425 POST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-1225
Practice Address - Country:US
Practice Address - Phone:614-336-9000
Practice Address - Fax:614-336-9001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073491208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2468637Medicaid
OHDO4131302Medicare ID - Type Unspecified
OHH87675Medicare UPIN