Provider Demographics
NPI:1932151719
Name:DOTY, WALTER J III (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:DOTY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-794-1148
Mailing Address - Fax:334-793-1954
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-794-1148
Practice Address - Fax:334-793-7592
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00012721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000027268Medicaid
GA000373722BMedicaid
AL51027268OtherBCBS ALABAMA
GA000373722BMedicaid
AL000027268Medicaid
AL27268Medicare ID - Type Unspecified