Provider Demographics
NPI:1902899149
Name:DOTY, DAVID KENNETH (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KENNETH
Last Name:DOTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 ARTISTS AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-2733
Mailing Address - Country:US
Mailing Address - Phone:229-740-1027
Mailing Address - Fax:229-235-3810
Practice Address - Street 1:555 ARTISTS AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-2733
Practice Address - Country:US
Practice Address - Phone:229-740-1027
Practice Address - Fax:229-235-3810
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME930242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3323297OtherMEDICARE 855R
KY91716OtherSIHO-KCR
KY64129620Medicaid
GA00875641AMedicaid
KY3427936000OtherPASSPORT ADVANTAGE
VA010348293Medicaid
PA102112303Medicaid
KY50017681OtherPASSPORT-KCR
KY000000548193OtherANTHEM-KCR
PA102112303Medicaid
KY593617Medicare PIN
OHDO7381591Medicare PIN
GAH16316Medicare UPIN
PA123334-FLTMedicare PIN
KY0998894Medicare PIN
KY00011007Medicare PIN
KY50017681OtherPASSPORT-KCR
KY3427936000OtherPASSPORT ADVANTAGE
VA12539P27Medicare PIN