Individual
DR. ROY A DOORENBOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 4TH AVE, GRINNELL, IA 50112-0780
(641) 236-2500
(641) 236-2539
Mailing address
PO BOX 780, GRINNELL, IA 50112-0780
(641) 236-2500
(641) 236-2539
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25226
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0294322
—
IA
01
—
25244
BCBS PROV #
IA
01
—
421300342501120001
TRICARE NUMBER
IA
05
—
6037523
—
IA
01
—
DE1784
RR MEDICARE GROUP #
IA
Enumeration date
09/01/2005
Last updated
10/12/2007
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