MEDICARE: DR. ERIN GAUTIER DOTY MD

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	2084N0400X	Neurology Physician	ME90477	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46878	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1790866747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN GAUTIER DOTY MD

Provider Business Mailing Address
First Line	:	7807 BAYMEADOWS RD E
Second Line	:	STE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-730-3689
Fax Number	:	904-730-3688

Provider Business Practice Location Address
First Line	:	7807 BAYMEADOWS RD E STE 401
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9668
Country	:	US
Telephone Number	:	904-730-3689
Fax Number	:	904-730-3688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/09/2010

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