Provider Demographics
NPI:1982694659
Name:DORSHER, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:DORSHER
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-240-2205
Mailing Address - Fax:320-229-5174
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-240-2205
Practice Address - Fax:320-229-5174
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23508207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100000453OtherMEDICARE
2900273OtherMEDICA HEALTH PLANS
600909OtherARAZ GROUP/AMERICA'S PPO
6D062DOOtherBLUE CROSS BLUE SHIELD
COMPOtherONE HEALTH PLAN/GREAT WES
110897OtherU CARE
986007OtherPREFERRED ONE
505R1DO(PL)OtherBLUE CROSS BLUE SHIELD
HP25426OtherHEALTH PARTNERS
800124OtherFIRST HEALTH PLAN
COMPOtherCHAMPUS
COMPOtherMMSI
110104489OtherRR MEDICARE
795068300OtherMEDICAL ASSISTANCE
A96066Medicare UPIN