Provider Demographics
NPI:1588827034
Name:DOTY, DONALD DEANE JR (CPO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DEANE
Last Name:DOTY
Suffix:JR
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 POCO CERRO CT SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4193
Mailing Address - Country:US
Mailing Address - Phone:505-323-8187
Mailing Address - Fax:
Practice Address - Street 1:124 ALVARADO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2940
Practice Address - Country:US
Practice Address - Phone:505-266-1700
Practice Address - Fax:505-266-1701
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist