Basic Information
Provider Information
NPI: 1295767606
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FURGERSON
FirstName: DOROTHY
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1691 THE ALAMEDA
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951262203
CountryCode: US
TelephoneNumber: 4087953605
FaxNumber: 4082870405
Practice Location
Address1: 1691 THE ALAMEDA
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951262203
CountryCode: US
TelephoneNumber: 4082877526
FaxNumber: 4089716963
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 09/02/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XG55843CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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