Provider Demographics
NPI:1912681701
Name:DORRIS, CHANDLER WILLIAM
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:WILLIAM
Last Name:DORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 JOHANN DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4677
Mailing Address - Country:US
Mailing Address - Phone:573-979-9152
Mailing Address - Fax:
Practice Address - Street 1:87 JOHANN DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4677
Practice Address - Country:US
Practice Address - Phone:573-979-9152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program