Provider Demographics
NPI:1790708048
Name:KAMMERER-DOAK, DOROTHY (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:KAMMERER-DOAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 MONTGOMERY BLVD NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1233
Mailing Address - Country:US
Mailing Address - Phone:505-888-0443
Mailing Address - Fax:505-888-1398
Practice Address - Street 1:4705 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1226
Practice Address - Country:US
Practice Address - Phone:505-888-0443
Practice Address - Fax:505-888-1398
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93295207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9273Medicaid
NM9273Medicaid