Provider Demographics
NPI:1790866747
Name:DOTY, ERIN GAUTIER (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:GAUTIER
Last Name:DOTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:GAUTIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7807 BAYMEADOWS RD E
Mailing Address - Street 2:STE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-730-3689
Mailing Address - Fax:904-730-3688
Practice Address - Street 1:7807 BAYMEADOWS RD E STE 401
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9668
Practice Address - Country:US
Practice Address - Phone:904-730-3689
Practice Address - Fax:904-730-3688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME904772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46878OtherBCBS
FL46878ZMedicare ID - Type Unspecified
I21701Medicare UPIN
FL46878YMedicare PIN
FL46878OtherBCBS