Basic Information
| Provider Information | |||||||||
| NPI: | 1437572534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DVORAK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 13TH AVE E | ||||||||
| Address2: | |||||||||
| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580783468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013640060 | ||||||||
| FaxNumber: | 7013640065 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 13TH AVE E | ||||||||
| Address2: | |||||||||
| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580783468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013640060 | ||||||||
| FaxNumber: | 7013640065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2014 | ||||||||
| LastUpdateDate: | 01/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 491 | ND | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.