Provider Demographics
NPI:1144232992
Name:DOLL, PETER JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:DOLL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2927
Mailing Address - Country:US
Mailing Address - Phone:270-827-2548
Mailing Address - Fax:270-827-4557
Practice Address - Street 1:323 8TH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2927
Practice Address - Country:US
Practice Address - Phone:270-827-2548
Practice Address - Fax:270-827-4557
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000639A213E00000X
KY00183213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000039574OtherBCBS
1118554OtherPASSPORT
IN200088150AMedicaid
480032960OtherRAILROAD MEDICARE
1191087OtherCHA
KY80001837Medicaid
IN638270Medicare ID - Type Unspecified
KY80001837Medicaid
480032960OtherRAILROAD MEDICARE
IN200088150AMedicaid
KY0795120002Medicare NSC