Individual
JAMES EDWARD O'DORISIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
76 BROOKWOOD AVE, SANTA ROSA, CA 95404-4312
(707) 578-3000
(707) 540-6407
Mailing address
76 BROOKWOOD AVE, SANTA ROSA, CA 95404-4312
(707) 578-3000
(707) 540-6407
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
A44147
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
A44147
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A441470
BLUE SHIELD OF CALIFORNIA
CA
05
—
00A441470
—
CA
01
—
P00462712
RAILROAD MEDICARE
—
Enumeration date
12/22/2006
Last updated
08/11/2015
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