Provider Demographics
NPI:1649808643
Name:LOR, DOROTHY M
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:LOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 5TH ST SE STE 1200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4688
Mailing Address - Country:US
Mailing Address - Phone:253-697-4747
Mailing Address - Fax:
Practice Address - Street 1:1450 5TH ST SE STE 1200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4688
Practice Address - Country:US
Practice Address - Phone:253-697-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA186206207RS0012X
WAMD.61564766207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine