Provider Demographics
NPI:1952772196
Name:DOHRMAN, GAYLE
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:DOHRMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2628
Mailing Address - Country:US
Mailing Address - Phone:208-769-1409
Mailing Address - Fax:
Practice Address - Street 1:2195 IRONWOOD CT
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2628
Practice Address - Country:US
Practice Address - Phone:208-769-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist