Provider Demographics
NPI:1437488137
Name:PETER J. DOLL, D.P.M.
Entity Type:Organization
Organization Name:PETER J. DOLL, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DM./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:270-827-2548
Mailing Address - Street 1:323 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420
Mailing Address - Country:US
Mailing Address - Phone:270-827-2548
Mailing Address - Fax:270-827-4557
Practice Address - Street 1:323 8TH ST.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-827-2548
Practice Address - Fax:270-827-4557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER J. DOLL DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies