MEDICARE: DOLLY P DOCTOR MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J0476	TX

General Provider Information

NPI Number	:	1740735729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLLY P DOCTOR MD PA

Provider Business Mailing Address
First Line	:	2817 W LOOP 250 N STE A
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-3205
Country	:	US
Telephone Number	:	432-686-9999
Fax Number	:	432-685-1700

Provider Business Practice Location Address
First Line	:	2817 W LOOP 250 N STE A
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-3205
Country	:	US
Telephone Number	:	432-686-9999
Fax Number	:	432-685-1700

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. DOLLY DOCTOR
Credential	:	M.D.
Telephone Number	:	432-686-9999

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	01/03/2017

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