Provider Demographics
NPI:1336361476
Name:DONNA SUE DOLLE, M.D., P.A.
Entity Type:Organization
Organization Name:DONNA SUE DOLLE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-333-8840
Mailing Address - Street 1:2060 SPACE PARK DR STE 304
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3675
Mailing Address - Country:US
Mailing Address - Phone:281-333-8840
Mailing Address - Fax:281-335-7598
Practice Address - Street 1:2060 SPACE PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3675
Practice Address - Country:US
Practice Address - Phone:281-333-8840
Practice Address - Fax:281-335-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG33206Medicare UPIN