Provider Demographics
NPI:1982032934
Name:DOYON, ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:DOYON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:DOYON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTN MSS
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-755-8107
Mailing Address - Fax:
Practice Address - Street 1:1635 CAREGIVER CIR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8529
Practice Address - Country:US
Practice Address - Phone:605-755-6100
Practice Address - Fax:605-755-6101
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD239213E00000X
OH59.000488213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH59.000488OtherSTATE OF OHIO RESIDENCY TRAINING CERTIFICATE
OHH401780Medicare PIN