Organization
WEST TEXAS NEUROSURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN K DORMAN M.D. (PRESIDENT/OWNER)
(432) 580-4700
Entity
Organization
Contact information
Practice address
8050 E HIGHWAY 191, SUITE 212, ODESSA, TX 79765-8613
(432) 580-4700
(432) 332-2678
Mailing address
8050 E HIGHWAY 191, SUITE 212, ODESSA, TX 79765-8613
(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
BCBS INDIVIDUAL NUMBER
TX
01
—
L4342
TEXAS LICENSE
TX
Enumeration date
03/02/2007
Last updated
02/26/2015
Update your record
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