Provider Demographics
NPI:1265410021
Name:DOVRE, PER ARNE (MD)
Entity type:Individual
Prefix:MR
First Name:PER
Middle Name:ARNE
Last Name:DOVRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PER
Other - Middle Name:ARNE
Other - Last Name:JOHANSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6283 CLARK RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-872-2229
Mailing Address - Fax:530-872-2229
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:SUITE 8
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-872-2229
Practice Address - Fax:530-872-3808
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19317207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G193170Medicaid
A40602Medicare UPIN
CA00G193170Medicare ID - Type Unspecified