Provider Demographics
NPI:1437195500
Name:DOTY, DOUGLAS JOHN (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOHN
Last Name:DOTY
Suffix:
Gender:M
Credentials:DO
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 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:3700 WASHINGTON AVE
Practice Address - Street 2:ST MARYS MEDICAL CENTER ANESTHESIA DEPT
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47750
Practice Address - Country:US
Practice Address - Phone:812-495-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002893A207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000035484OtherBLUE SHIELD
P00221219OtherRAILROAD MEDICARE
KY64111024Medicaid
IN200056180Medicaid
A17241Medicare UPIN
P00221219OtherRAILROAD MEDICARE