Provider Demographics
NPI:1366485765
Name:DOTY, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:DOTY
Suffix:
Gender:M
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:PO BOX 911268
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1268
Mailing Address - Country:US
Mailing Address - Phone:512-419-9733
Mailing Address - Fax:512-454-4575
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1165
Practice Address - Country:US
Practice Address - Phone:512-419-9733
Practice Address - Fax:512-451-3709
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9054207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX830004595OtherRAILROAD MEDICARE NUMBER
TX135830105Medicaid
TX89549FMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX135830105Medicaid