Individual
JOHN KYLE DORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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