Individual
DR. KODY DUANE DORMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-4940
Mailing address
400 E CEDAR ST, PERRY, OK 73077-7833
(580) 336-7670
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036162380
IL
208000000X
Pediatrics Physician
036162380
IL
Other
Enumeration date
03/26/2020
Last updated
10/03/2024
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