Individual
JOB DORNAIVIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6130 TOURS CT APT 105, INDIANAPOLIS, IN 46220-4617
(302) 390-7772
Mailing address
6130 TOURS CT APT 105, INDIANAPOLIS, IN 46220-4617
(302) 390-7772
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
21-177
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121114371299
—
IN
Enumeration date
05/20/2022
Last updated
05/20/2022
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