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General NPI Number Information
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NPI Number | 1396067831
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Entity Type | Organization
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Legal Business Name | MICHAEL DOLE MD, A PROFESSIONAL MEDICAL CORP.
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 5408 PROVINE PL
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3772
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Country | US
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Telephone | 318-449-8333
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Fax | 318-449-8328
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Provider Business Mailing Address
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Address Line | PO BOX 12658
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City | ALEXANDRIA
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State | LA
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Zip | 71315-2658
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Country | US
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Telephone | 318-449-8333
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Fax | 318-449-8328
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL W DOLE
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Credential | M.D.
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Telephone | 318-449-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD.10521R
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License Number State | LA
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