Individual
RUSSELL K DORER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD,PHD
Contact information
Practice address
825 EASTLAKE AVE E, SEATTLE, WA 98109-4405
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
MD00046178
WA
207ZP0101X
Anatomic Pathology Physician
Primary
MD00046178
WA
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
MD00046178
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039575
L&I
WA
01
—
5949DO
BLUE SHIELD
WA
01
—
7972795
AETNA
WA
05
—
8463630
—
WA
Enumeration date
07/21/2006
Last updated
02/25/2025
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