Provider Demographics
NPI:1417929225
Name:DOTY, PAUL MANSFIELD (M D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MANSFIELD
Last Name:DOTY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2327
Mailing Address - Country:US
Mailing Address - Phone:985-892-2200
Mailing Address - Fax:985-892-1440
Practice Address - Street 1:1115 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2327
Practice Address - Country:US
Practice Address - Phone:985-892-2200
Practice Address - Fax:985-892-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03425R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171468Medicaid
LA720922555OtherFEDERAL TAX I
LA1171468Medicaid
LAB89480Medicare UPIN