Individual
JOHN KYLE DORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
540 W 5TH ST STE 320, ODESSA, TX 79761-5002
(432) 580-4700
(432) 332-2678
Mailing address
540 W 5TH ST STE 320, ODESSA, TX 79761-5002
(432) 580-4700
(432) 332-2678
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
L4342
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004QF
BCBS GROUP NUMBER
TX
05
—
165059001
—
TX
05
—
166114201
—
TX
01
—
8AJ418
BLUE CROSS BLUE SHIELD INDIVIDUAL NUMBER
TX
01
—
L4342
PHYSICIAN LICENSE
TX
Enumeration date
09/06/2006
Last updated
03/25/2014
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