National Provider Identifier
Jack William Dormer, PA
Jack William Dormer, PA is listed in the NPPES registry with a primary specialty of Physician Assistant in Williamsville, NY and a listed phone number of (716) 204-3200.
Profile Overview
- NPI
- 1285317024
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- August 09, 2023
- Last Updated
- August 09, 2023
Practice Location
- 111 North Maplemere Road
- Suite 100
- Williamsville, NY 14221
Phone: (716) 204-3200
Mailing Address
- 4225 Genesee St Ste 400
- Cheektowaga, NY 14225-1994
Specialties
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1285317024
- Entity Type
- Individual
- Last Name
- Dormer
- First Name
- Jack
- Middle Name
- William
- Credential
- PA
- Mailing Street Address
- 4225 Genesee St Ste 400
- Mailing City
- Cheektowaga
- Mailing State
- NY
- Mailing ZIP Code
- 14225-1994
- Mailing Country
- US
- Mailing Phone
- (716) 204-3200
- Practice Street Address
- 111 North Maplemere Road
- Practice Address Line 2
- Suite 100
- Practice City
- Williamsville
- Practice State
- NY
- Practice ZIP Code
- 14221
- Practice Country
- US
- Practice Phone
- (716) 204-3200
- Practice Fax
- (716) 204-4337
- Enumeration Date
- August 09, 2023
- Last Updated
- August 09, 2023
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- August 07, 2023
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)