Provider Demographics
NPI:1366687881
Name:DONALD D. DOTY, M.D.
Entity Type:Organization
Organization Name:DONALD D. DOTY, M.D.
Other - Org Name:DOTY FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-337-3661
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-0773
Mailing Address - Country:US
Mailing Address - Phone:909-337-3661
Mailing Address - Fax:909-337-3570
Practice Address - Street 1:29099 HOSPITAL ROAD SUITE 112
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-337-3661
Practice Address - Fax:909-337-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G60930Medicare PIN