Provider Demographics
NPI:1740735729
Name:DOLLY P DOCTOR MD PA
Entity Type:Organization
Organization Name:DOLLY P DOCTOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-686-9999
Mailing Address - Street 1:2817 W LOOP 250 N STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3205
Mailing Address - Country:US
Mailing Address - Phone:432-686-9999
Mailing Address - Fax:432-685-1700
Practice Address - Street 1:2817 W LOOP 250 N STE A
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3205
Practice Address - Country:US
Practice Address - Phone:432-686-9999
Practice Address - Fax:432-685-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF40567Medicare UPIN