Provider Demographics
NPI:1629201371
Name:ERIN DOTY MD PA
Entity Type:Organization
Organization Name:ERIN DOTY MD PA
Other - Org Name:FIRST COAST NEUROSCIENCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-730-3689
Mailing Address - Street 1:7807 BAYMEADOWS RD E
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9664
Mailing Address - Country:US
Mailing Address - Phone:904-730-3689
Mailing Address - Fax:904-730-3688
Practice Address - Street 1:7807 BAYMEADOWS RD E
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9664
Practice Address - Country:US
Practice Address - Phone:904-730-3689
Practice Address - Fax:904-730-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME904772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDQ0865OtherR.R. MEDICARE
FL46878OtherBCBS
CV985AMedicare PIN