Provider Demographics
NPI:1437291218
Name:DAVID E. DOLLENS, MD,LLC
Entity Type:Organization
Organization Name:DAVID E. DOLLENS, MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:DOLLENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-522-2700
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-0968
Mailing Address - Country:US
Mailing Address - Phone:812-522-2700
Mailing Address - Fax:812-522-1057
Practice Address - Street 1:209 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2311
Practice Address - Country:US
Practice Address - Phone:812-522-2700
Practice Address - Fax:812-522-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027033A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000101760OtherANTHEM
IN164160Medicare ID - Type Unspecified
IN000000101760OtherANTHEM