Provider Demographics
NPI:1558361063
Name:DOTY, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:DOTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 BAYOU BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2698
Mailing Address - Country:US
Mailing Address - Phone:850-433-3300
Mailing Address - Fax:850-433-9709
Practice Address - Street 1:4700 BAYOU BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2698
Practice Address - Country:US
Practice Address - Phone:850-433-3300
Practice Address - Fax:850-433-9709
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36607207RC0000X
AL7355207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009946845Medicaid
FL395561 00Medicaid
FL17477YMedicare PIN
AL102I062440Medicare PIN
FLD53299Medicare UPIN