Healthcare Provider Details

I. General information

NPI: 1124053707
Provider Name (Legal Business Name): RICHARD D DOTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33758 YUCAIPA BLVD
YUCAIPA CA
92399-5105
US

IV. Provider business mailing address

PO BOX 2200
REDLANDS CA
92373-0722
US

V. Phone/Fax

Practice location:
  • Phone: 909-795-9747
  • Fax: 909-797-1191
Mailing address:
  • Phone: 909-793-3311
  • Fax: 909-335-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG30266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: