1437195500 NPI number — DOUGLAS JOHN DOTY DO

Table of content: DOUGLAS JOHN DOTY DO (NPI 1437195500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437195500 NPI number — DOUGLAS JOHN DOTY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOTY
Provider First Name:
DOUGLAS
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437195500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47731-3276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-473-0181
Provider Business Mailing Address Fax Number:
812-473-5822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
ST MARYS MEDICAL CENTER ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-495-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  02002893A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: 02002893A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00000035484 . This is a "BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00221219 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64111024 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200056180 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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