Provider Demographics
NPI:1407933906
Name:DOKE, LARRY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:DOKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45135
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-5135
Mailing Address - Country:US
Mailing Address - Phone:505-994-4392
Mailing Address - Fax:505-994-4392
Practice Address - Street 1:1400 BARBARA LOOP
Practice Address - Street 2:SUITE I
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87174-5135
Practice Address - Country:US
Practice Address - Phone:505-994-4392
Practice Address - Fax:505-994-4392
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM265103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
173089OtherMANAGED HEALTH NETWORK
17736OtherBLUE CROSS BLUE SHIELD
NM100601OtherVALUE OPTIONS OF NM
NMN8677Medicaid
42761OtherPRESBYTERIAN HEALTH PLAN
2001884OtherCIGNA BEHAVIORAL HEALTH
9872OtherLOVELACE HEALTH PLAN