Provider Demographics
NPI:1174504161
Name:DOTY, CATHERINE J (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:J
Last Name:DOTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 WOODLAKE DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5740
Mailing Address - Country:US
Mailing Address - Phone:314-205-8858
Mailing Address - Fax:314-205-2113
Practice Address - Street 1:1585 WOODLAKE DR
Practice Address - Street 2:SUITE 214
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5740
Practice Address - Country:US
Practice Address - Phone:314-205-8858
Practice Address - Fax:314-205-2113
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100753208000000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO907554134Medicare ID - Type UnspecifiedMISSOURI MEDICARE ID#
G75681Medicare UPIN