Healthcare Provider Details

I. General information

NPI: 1508836750
Provider Name (Legal Business Name): MATTHEW K. DOTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MONROE ST
PELLA IA
50219-1189
US

IV. Provider business mailing address

405 MONROE ST
PELLA IA
50219-1189
US

V. Phone/Fax

Practice location:
  • Phone: 641-628-6650
  • Fax: 641-620-2301
Mailing address:
  • Phone: 641-628-6650
  • Fax: 641-620-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33093
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number33093
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: