Provider Demographics
NPI:1841417896
Name:DORWARD, IAN GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:GORDON
Last Name:DORWARD
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:636-916-7140
Mailing Address - Fax:636-916-7139
Practice Address - Street 1:100 ENTRANCE WAY
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY, STE B
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1645
Practice Address - Country:US
Practice Address - Phone:636-916-7140
Practice Address - Fax:636-916-7139
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003191207XS0117X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200008324Medicaid