Healthcare Provider Details

I. General information

NPI: 1194914317
Provider Name (Legal Business Name): DAVID G DOCTOR MD ORTHOPAEDICS AND SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW STREET SUITE 305
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

PO BOX 789
LUDLOW MA
01056-0789
US

V. Phone/Fax

Practice location:
  • Phone: 413-788-7321
  • Fax: 413-733-6369
Mailing address:
  • Phone: 413-509-1000
  • Fax: 413-509-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number080082
License Number StateMA

VIII. Authorized Official

Name: DR. DAVID G DOCTOR
Title or Position: PRESIDENT
Credential: MD
Phone: 413-788-7321