Healthcare Provider Details

I. General information

NPI: 1790866747
Provider Name (Legal Business Name): ERIN GAUTIER DOTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN GAUTIER MD

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7807 BAYMEADOWS RD E STE 401
JACKSONVILLE FL
32256-9668
US

IV. Provider business mailing address

7807 BAYMEADOWS RD E STE 401
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 904-730-3689
  • Fax: 904-730-3688
Mailing address:
  • Phone: 904-730-3689
  • Fax: 904-730-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME90477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: