Provider Demographics
NPI:1366694770
Name:DOTY, RAYMOND G (CRNP)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:G
Last Name:DOTY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-9628
Mailing Address - Country:US
Mailing Address - Phone:256-543-8714
Mailing Address - Fax:
Practice Address - Street 1:420 N 6TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3244
Practice Address - Country:US
Practice Address - Phone:256-492-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-048453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I500363Medicare PIN
AL510I500366Medicare PIN
AL510I500365Medicare PIN
AL510I500364Medicare PIN
AL510I500362Medicare PIN