Basic Information
| Provider Information | |||||||||
| NPI: | 1154640811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUMOR | ||||||||
| FirstName: | KORSHIE | ||||||||
| MiddleName: | SELORME | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MEDICAL PLZ | ||||||||
| Address2: | |||||||||
| City: | LAKE SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633671366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366255200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652120001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738828788 | ||||||||
| FaxNumber: | 5738823131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2010 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 2010020733 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | 2010020733 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 431560263 | 01 | TRICARE WEST | OTHER | 115464081 | 05 | MO | MEDICAID | P00852007 | 01 | RAILROAD MEDICARE GROUP #CB9013 | OTHER |