Provider Demographics
NPI:1760403679
Name:DOTI, ANTHONY R (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:DOTI
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 1:1340 EMPIRE CTRL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4022
Mailing Address - Country:US
Mailing Address - Phone:214-632-6394
Mailing Address - Fax:214-525-0664
Practice Address - Street 1:1340 EMPIRE CTRL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4022
Practice Address - Country:US
Practice Address - Phone:214-632-6394
Practice Address - Fax:214-525-0664
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166046603Medicaid
TX166046602Medicaid
TX166046601Medicaid
TX8C6421Medicare ID - Type Unspecified
TX8C6636Medicare ID - Type Unspecified
TX166046602Medicaid
TX8L2610Medicare PIN
TX8L2611Medicare PIN
TX166046601Medicaid