Provider Demographics
NPI:1508884743
Name:DOTY, DAVID HUNTER (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HUNTER
Last Name:DOTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 W LUGONIA AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-9703
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-890-0218
Practice Address - Street 1:2131 ELKS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5544
Practice Address - Country:US
Practice Address - Phone:909-726-6100
Practice Address - Fax:909-557-1745
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG271730207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43260Medicare UPIN
CAFU356ZMedicare PIN
CA00G271730Medicare PIN