Provider Demographics
NPI:1932258530
Name:DORSETT, REBECCA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:DORSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ROUND ROCK AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4006
Mailing Address - Country:US
Mailing Address - Phone:512-733-5800
Mailing Address - Fax:512-733-5804
Practice Address - Street 1:2300 ROUND ROCK AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4006
Practice Address - Country:US
Practice Address - Phone:512-733-5800
Practice Address - Fax:512-733-5804
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00487JMedicare ID - Type Unspecified
TXE02206Medicare UPIN