Provider Demographics
NPI:1801987300
Name:DORSEY, EUGENE RICHARD (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:RICHARD
Last Name:DORSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4032
Mailing Address - Country:US
Mailing Address - Phone:949-718-3666
Mailing Address - Fax:949-718-9666
Practice Address - Street 1:177 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4032
Practice Address - Country:US
Practice Address - Phone:949-718-3666
Practice Address - Fax:949-718-9666
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG128932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry