Provider Demographics
NPI:1952362311
Name:DORNA, ISAM (MD)
Entity type:Individual
Prefix:DR
First Name:ISAM
Middle Name:
Last Name:DORNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ISAM
Other - Middle Name:
Other - Last Name:NAOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4234
Mailing Address - Country:US
Mailing Address - Phone:534-034-5292
Mailing Address - Fax:253-301-6529
Practice Address - Street 1:401 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3715
Practice Address - Country:US
Practice Address - Phone:253-403-4532
Practice Address - Fax:253-403-1374
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60123479207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271029Medicaid
ORP00342101OtherRR MEDICARE
OR858463029OtherBCBS-MEDFORD
ORR136507OtherMEDICARE-TYPE UNSPECIFIED
ORR136507OtherMEDICARE-TYPE UNSPECIFIED
ORP00342101OtherRR MEDICARE
OR858463029OtherBCBS-MEDFORD