Organization
DORCHUCK MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD W DORCHUCK JR. MD (OWNER)
(208) 556-4803
Entity
Organization
Contact information
Practice address
801 E MULLAN AVENUE, OSBURN, ID 83849-0596
(208) 556-4803
(208) 556-1023
Mailing address
PO BOX 596, OSBURN, ID 83849-0596
(208) 556-4803
(208) 556-1023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-6906
ID
225100000X
Physical Therapist
PT-1871
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8M580
BLUE CROSS
ID
01
—
DD9081
MEDICARE RAILROAD
ID
Enumeration date
10/16/2006
Last updated
12/16/2008
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