| Brian Wallace Dorman, MD | |
|
2576 Renfren Street, Eureka, CA 95501 | |
| (707) 445-3257 | |
| (707) 445-1027 |
| Full Name | Brian Wallace Dorman |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Location | 2576 Renfren Street, Eureka, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447278122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | G24506 (California) | Primary |
| Entity Name | Providence Medical Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285890624 PECOS PAC ID: 8921993205 Enrollment ID: O20040216001346 |
| Entity Name | Telemedicine Group Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326338237 PECOS PAC ID: 9830351824 Enrollment ID: O20120509000349 |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Wallace Dorman, MD 2576 Renfren Street, Eureka, CA 95501 Ph: (707) 445-3257 | Brian Wallace Dorman, MD 2576 Renfren Street, Eureka, CA 95501 Ph: (707) 445-3257 |
James Kim Bauriedel, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 1303 G St, Eureka, CA 95501 Phone: 707-443-7778 | |
John Joseph Albertini, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2576 Renfrew Street, Eureka, CA 95501 Phone: 707-445-3257 Fax: 707-445-1027 |