Healthcare Provider Details

I. General information

NPI: 1437488137
Provider Name (Legal Business Name): PETER J. DOLL, D.P.M.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 8TH ST.
HENDERSON KY
42420
US

IV. Provider business mailing address

323 8TH ST.
HENDERSON KY
42420
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-2548
  • Fax: 270-827-4557
Mailing address:
  • Phone: 270-827-2548
  • Fax: 270-827-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER JAMES DOLL
Title or Position: DM./OWNER
Credential: D.P.M.
Phone: 270-827-2548