Provider Demographics
NPI:1275890204
Name:DOUTY, DANNY LEE (IDC)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:LEE
Last Name:DOUTY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2567 OLD QUARRY RD
Mailing Address - Street 2:#2404
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2789
Mailing Address - Country:US
Mailing Address - Phone:619-708-2847
Mailing Address - Fax:
Practice Address - Street 1:2ND BATTALION 1ST MARINES, 1ST MARINE DIVISION
Practice Address - Street 2:BOX: 555401
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5401
Practice Address - Country:US
Practice Address - Phone:760-763-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman