Provider Demographics
NPI:1457552234
Name:DORMAN, CARL W (CO,LO)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:W
Last Name:DORMAN
Suffix:
Gender:M
Credentials:CO,LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331580
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-1580
Mailing Address - Country:US
Mailing Address - Phone:361-888-7752
Mailing Address - Fax:361-888-7424
Practice Address - Street 1:2216 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4002
Practice Address - Country:US
Practice Address - Phone:956-686-0032
Practice Address - Fax:361-888-7424
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22Medicare ID - Type UnspecifiedORTHOTIST