Provider Demographics
NPI:1932389046
Name:J L DOOLEY DPM INC
Entity Type:Organization
Organization Name:J L DOOLEY DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-753-7772
Mailing Address - Street 1:200 1ST ST NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-2555
Mailing Address - Country:US
Mailing Address - Phone:330-753-7772
Mailing Address - Fax:330-753-2610
Practice Address - Street 1:200 1ST ST NW
Practice Address - Street 2:SUITE 2
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-2555
Practice Address - Country:US
Practice Address - Phone:330-753-7772
Practice Address - Fax:330-753-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001481D213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118830Medicaid
OHT80339OtherUPIN
OHT80339OtherUPIN