Provider Demographics
NPI:1730241910
Name:DORIOT, STACY ELIZABETH
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ELIZABETH
Last Name:DORIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 W AIMEE CT
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-6806
Mailing Address - Country:US
Mailing Address - Phone:812-752-8189
Mailing Address - Fax:812-752-9055
Practice Address - Street 1:1670 W AIMEE CT
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-6806
Practice Address - Country:US
Practice Address - Phone:812-752-8189
Practice Address - Fax:812-752-9055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN9039702080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics